TD Insurance's Niro Kandasamy on fraud

Insurance fraud is not always a staged crash or a fake injury. A lot of the real work sits in a much messier place — the claim where the facts look bad, but the intent is not obvious. That is the problem Niro Kandasamy, AVP of fraud and special investigations at TD Insurance, put front and center this week. His point was simple: insurers are often judging the gap between an honest oversight and a deliberate misrepresentation, and that gap is where claims decisions get hard. (insurancebusinessmag.com) ### What is the “grey zone” here? Kandasamy was talking about everyday situations that do not look like movie-version fraud. A driver takes a car out of winter storage and forgets to restore full coverage. A homeowner rents out a room on a short-term basis and never updates the policy. On paper, those can become clean coverage problems. In practice, they may reflect forgetfulness, confusion, or something more intentional. That ambiguity is what worries fraud teams. (insurancebusinessmag.com) ### Why is intent such a big deal? Because the same bad fact pattern can come from two very different behaviors. Someone might omit a detail to save money. Someone else might simply fail to realize the detail mattered. Kandasamy’s framing is that investigators need to “distill down” what actually happen(insurancebusinessmag.com)e from just spotting an anomaly and assuming the worst. (insurancebusinessmag.com) ### So how does TD say it handles that? The process starts with reconstruction. Claims can be flagged by frontline adjusters or automated tools, but Kandasamy says the next step is a series of questions designed to understand the sequence of events. Claimants get multiple opportunities to explain what h(insurancebusinessmag.com)g told. Only after that does the team move into deeper document gathering, like receipts or other evidence. (insurancebusinessmag.com) ### Why not just let the algorithm decide? Because “soft fraud” is exactly the kind of thing rules engines can overread. A flag can tell you that mileage was not updated or that a regular driver was left off a policy. But a flag cannot, by itself, tell you whether the customer understood the disclosure (insurancebusinessmag.com)n gets you to the file. Human judgment still decides what the pattern means. (insurancebusinessmag.com) ### How common are these misunderstood cases? Pretty common, if TD’s own survey is a guide. The company said Canadians correctly identified common real-world fraud scenarios only 58% of the time on average. At the same time, 90% said fraud raises premiums, 79% called it a serious issue, and 96% believed(insurancebusinessmag.com). People condemn fraud in the abstract, but often miss it in ordinary behavior. (insurancebusinessmag.com) ### What kinds of behavior are people missing? TD highlighted a handful of examples: not updating mileage after driving more, not disclosing tenants or short-term rental guests, registering a vehicle under a parent’s name to lower premiums, leaving a regular driver off the policy, and padding repair estimates. Some of those are p(insurancebusinessmag.com)payment, reduced coverage, or a deeper fraud review. (insurancebusinessmag.com) ### Why does this matter beyond one interview? Because it says something bigger about how SIU teams and claims operations need to work now. Fraud programs are under pressure to catch more, earlier, and with more automation. But if the fastest-growing problem is the blurry middle — omissions, half-truths, stale policy details — then the real skill is not just detection. It is triage with nuance. The system has to separate risk signals from intent. (insurancebusinessmag.com) ### Bottom line? Kandasamy’s message is that the hardest fraud cases are not the obvious ones. They are the ordinary claims where a missing detail could be either a mistake or a scheme. And with TD’s survey showing how poorly consumers recognize those scenarios, insurers are being pushed to do two jobs at once — investigate smarter and educate earlier. (insurancebusinessmag.com)