What is insurance fraud?

Insurance fraud is often perceived as a victimless crime, where no one is hurt.  The reality is very different.  The amount of premium paid by policyholders is affected by additional costs induced by insurance fraudsters.

Insurance fraud includes:

  • Entering an insurance contract without providing truthful answers in the proposal form;
  • Making a claim under an insurance contract for a loss based on misleading or untruthful circumstances; and
  • Otherwise being misleading or untruthful in interactions with an insurer with the intention of gaining a benefit under the insurance contract.

Since the premium reflects the type of risk which a policyholder transfers to an insured pool of similar risks, being deceptive about a given risk ends up imposing an unfair cost on other honest policyholders who end up covering risks that should not form part of the pool of risks which they have joined.

Insurers are committed to investigate all potential frauds in order to ensure that honest policyholders do not end up subsidizing fraudulent claims through higher premiums.  For this reason, insurers routinely exchange information on customers’ claims history to help them identify potential frauds.  Such investigation has brought to surface several cases of suspected insurance fraud.

Committing insurance fraud (whether when applying for insurance or when claiming) is also likely to have long and serious consequences on the fraudster.  Besides endangering recoveries on genuine claims, fraudsters can face criminal prosecution and possibly a jail sentence and can expect to find it harder to get, and pay more for, future insurance.

By clicking here you return to the main page of this link.