Insurance fraud

 
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In the last year alone, insurance companies' payments to fraudsters amounted to over 50 billion rubles. This amount is 10% of all insurance payments for 2016.

A favorite area of insurance fraudsters is auto insurance. The share of payments for car insurance is one fifth of the total amount. This also includes controversial situations when the insured person is trying to unlawfully increase the amount of compensation, but there is no direct evidence. The share of payments to fraudsters for life, health and property insurance is one tenth of the total. But it is possible to prove the fact of insurance fraud in court only in 1% of cases. The insurers managed to return only five billion rubles out of the fifty paid.

Insurance companies are confident that the number of fraudsters will continue to grow. This is due to a decrease in the standard of living of the population. Analysis of insurance fraud over the past years shows that during the crisis, the number of financial fraud increases. The record number of fraud cases occurred in 1998 and 2008.

The increase in the number of insurance fraud forces insurers to include in the tariff for the client the estimated damage from fraud.

Reasons for insurance fraud

The current situation, when insurance companies are forced to pay in doubtful situations, and it is incredibly difficult to prove the fact of fraud in court, has its own reasons:

Involvement of law enforcement officials in insurance fraud. In most cases, such frauds are associated with forgery.

Loyal attitude of the majority of people to receiving improper benefits. Some citizens simply do not trust insurance companies, while others do not see anything reprehensible in such deception.

The Russian Union of Auto Insurers (RSA) conducted a survey, which revealed that 30% of citizens believe that all insurance companies are deceiving customers, so they do not consider it a crime to overestimate the amount of losses if possible.

Liability insurance companies are seeing a picture of fraud in this area:

The fourth part of incidents falls on the registration of a CTP insurance policy after the occurrence of an insured event.

A third of the fraud is associated with the staging of an insured event (RTA).

About 15% of fraudsters deliberately falsify facts related to the insured event (for example, the fact that the driver was drunk or took drugs).

Fraud of employees of insurance companies

More than half of all facts of insurance fraud in the Russian Federation are carried out with the help of employees of insurance organizations. Even criminal communities may form, based on an unscrupulous insurance worker who decides to use his position in order to obtain illegal profits.

The security departments of insurance companies record the following facts of fraud:

Registration of the insurance contract in hindsight (after the onset of the insurance situation).

Deliberate exaggeration of real damage to increase the amount of insurance payments. In this case, the insurance employee is entitled to a percentage of the compensation received.

Collusion of an insurance employee, service station employees and a client. In this case, the cost of repair work and spare parts requiring replacement is overstated. The difference between the actual costs and the insurance compensation paid is divided among the three interested parties.

Distortion of the facts of the occurrence of the insurance situation in order to receive compensation.

Distribution of counterfeit insurance policies or blank contract forms.

Customer fraud

Clients try to cheat their insurance organization by:

Agreements with an expert assessing the damage incurred and its causal relationship with the insured event. Usually, the expert is offered material compensation for deliberately overstating the amount of damage, and, consequently, compensation under the insurance contract.

Fake insurance documents. For example, a fake OSAGO policy allows the car owner to avoid fines from the traffic police when checking documents. It will not be possible to receive insurance compensation under such a policy, but it is quite possible to significantly save on third party liability insurance.

Life, health or car insurance from different insurers in order to receive compensation for one incident several times.

Staging a car theft. In this case, it is extremely problematic to prove the fact of insurance fraud.

Fraud involving third parties

Insurance fraud is often carried out by seemingly uninterested persons. Participants will be required for such insurance scams:

Simulation of an accident or other insurance incident. Such fraud will require the assistance of police officers, doctors or firefighters. They will prepare false protocols, medical certificates, extracts from a non-existent medical history, expert assessments for obtaining insurance compensation.

Concealment of circumstances related to the insured event. Experts, police officers, doctors, ambulance workers, fake witnesses can be involved in such a fraud scheme.

It should be noted that in real life, various insurance fraud schemes are interconnected. Having unraveled the insurance scam, you can find out that the clients of the insurance company, and its employees, and representatives of law enforcement agencies, and experts, and doctors took part in it for the purpose of profit. Such organized crime in the insurance industry makes it very difficult to disclose fraud and is the reason for the growth of losses in the insurance business.

Examples of insurance fraud

In the insurance industry, there are simply egregious cases of fraud. Five of the most sensational scams of recent years.

Kill for insurance

A group of swindlers from Volgograd tried to demand compensation in the amount of sixteen and a half million rubles from insurance companies. The client signed life insurance contracts for two and a half million rubles with six insurers, which included such companies as Renaissance Insurance, Alliance, RESO - Garantia.

Compensation payments under the insurance contract relied on his friends. Two months later, the body of a man was found near the river in the center of the city. The deceased's hands and feet were cut off and his face was disfigured. Friends of the insured confirmed that he was their friend, additionally informing the police that the deceased loved to swim in the river.

By contacting the insurers, the friends were able to receive compensation under an insurance contract from several companies. Security officers from other insurance companies conducted an investigation into the incident, which involved law enforcement officials.

As a result of the investigation, a "deceased" client was found, he, of course, turned out to be not only alive, but also healthy. At the end of 2014, a trial was held, which sentenced the insured to three years in prison, and his accomplices to two and a half years in prison.

Car that died twice

The car owner from Armavir, through an agent, entered into a CASCO insurance contract for a car with the MAKS company, and six months later he filed an insurance claim for car theft. According to the client, his car was stolen from the parking lot of one of the restaurants in Armavir. The amount of compensation under the auto insurance contract was two million rubles.

The insurance security service conducted an investigation, during which it turned out that more than a year ago (before the conclusion of the insurance contract with MAKS) the “stolen” car was severely damaged and could not be repaired.

It was also found that the insured purchased the car body, keys and a set of documentation from the previous owner. After completing the insurance contract, the client sold the car body for scrap, receiving eight thousand rubles for it. After the sale of the body, the client turned to the insurance company with a statement about the theft of the car. Law enforcement officers terminated the investigation into the theft and opened new criminal proceedings on charges of the client under the articles providing for liability for insurance fraud and deliberately false notification of law enforcement officers about the committed offense.

Disease concealment

A woman living in Krasnodar decided to deceive the VSK insurance company and receive compensation in the amount of twenty million rubles under a life and health insurance contract. A resident of Krasnodar was diagnosed with a violation of the musculoskeletal system. This disease is chronic and is a direct indication for disability registration.

Instead of going to the VKK, the woman went to the bank, where she received a loan in the amount of twenty million rubles using falsified salary certificates. After receiving a loan, the woman signed a life and health insurance contract with VSK, according to which disability of the first or second group is an insured event, for which compensation payments are relied on.

The client did not notify the insurance company about the diagnosis of the disease, which is the basis for obtaining a disability group. After waiting four months, the insured filed an application with the bureau of medical and social examination and registered a disability. With the documents in hand, the client turned to the insurance company with a demand to pay compensation under the insurance contract. The VSK security service managed to establish that the diagnosis was made to the client before receiving a loan and signing an insurance contract. During the trial, the woman was found guilty of attempted fraud and sentenced to three years of probation.

Fake home

And the residents of Volgograd have invented a new method of fraud. They signed a home insurance contract with VSK in the amount of sixty-eight million rubles. But instead of real houses, they insured dummies. The dummies were presented as residential buildings under construction, the total area of which was two thousand square meters. Non-existent houses were located in the countryside.

As evidence of the construction costs, the scammers provided the insurance package with fake documents, including invoices, construction contracts and other financial documents.

A few months after the insurance contract was drawn up, the nonexistent houses were burned down, and the fraudsters applied for insurance compensation. This fact aroused suspicion, and the VSK security officers began an investigation. They found out that the elite new building actually turned out to be a fake. It was not the mansions that burned down, but the utility rooms without a foundation, roof, windows and communications. When concluding an insurance contract, the clients deliberately deceived the VSK employee who executed it. The overestimation of the real value of the insured property was necessary to increase compensation for its damage in the event of an insurance incident.

The disclosure of the fact of insurance fraud became a valid reason for the refusal of the insurance company to pay compensation to the scammers. However, the scammers did not want to settle the matter peacefully. They filed a claim with the court demanding to recover from the insurance company the due compensation in the amount of sixty-eight million rubles.

Insurance representatives managed to prove their case in court. The police opened a criminal case on the fact of large-scale fraud. Already another, criminal, court passed a suspended sentence with a two-year probation period.

She was insured against not leaving

An employee of a travel company received compensation from the RESO-Garantia insurance company in the amount of seven million rubles, by falsifying the insurance event. The woman has drawn up a "cancellation" insurance contract. It provides for a compensation payment in the amount of the costs incurred for the purchase of a voucher, if it is impossible to leave for reasons beyond the control of the client. The developed fraud scheme turned out to be simple: using her official position, the woman executed insurance contracts for clients, information about which was in the database of the travel agency. Most people did not even know that they were involved in insurance fraud.

The tour operator has developed a whole fraudulent scheme: it falsified the refusals of consulates to issue visas, financial documents for paying for vouchers. Over the course of several years, the swindler managed to obtain insurance compensations on behalf of one hundred and fifty unsuspecting clients. And her income from fraud amounted to seven million rubles. After the opening of criminal proceedings and the presentation of charges, the former travel agent is on recognizance not to leave. There is still no court decision on the case. And the swindler "shines" up to ten years in prison.


More real-life cases of employee fraud! To read.


Methods for dealing with insurance scams

All types of fraud can be roughly divided into two categories: professional and amateur or domestic.

Methods of combating professional fraud are the prerogative of law enforcement officers, and they are included in the scope of operational activities. Thanks to standard "do-it-yourself" methods, it is unlikely that it will be possible to uncover a professional fraud scheme. Such criminals operate as part of well-organized groups with corrupt connections both among law enforcement officers and judges. And the insurance company alone cannot resist such fraud.

But special methods of combating domestic fraud are not required. Fighting amateur swindlers is the main task of the security service of an insurance company. And such a struggle consists in preventing the receipt of illegal insurance payments and bringing to justice, including criminal, those responsible. The number of individuals attempting to cheat insurance premiums is very high. This is due to the Russian mentality: the majority of citizens do not consider it a crime to cheat the insurance company, and some of them even brag about it on social networks.

Insurance companies, despite the competition for customers, join forces and share with each other methods of combating fraud. Thus, the participants in auto insurance rallied under the leadership of the RSA (Russian Union of Auto Insurers). He launched the Bureau of Insurance Histories project three years ago, in which insurers work together to counter fraud.

Another method of combating fraud was the initiative of the union of insurance companies, in accordance with which the Ministry of Finance of Russia prepared a draft amendments to the Criminal Code of the Russian Federation. It suggests the addition of an article criminalizing fraud in the provision of insurance services. The punishment for fraud is provided for both unscrupulous clients and employees of insurance companies.

It should be noted and strengthening of methods of counteraction and prevention of fraud on the part of law enforcement officers. If five years ago the police did not want to investigate a case that was obviously lost in court, today the attitude of the court towards insurance swindlers is more strict. There is a solid judicial practice of punishing those guilty of insurance fraud.

The method for countering internet fraud is simple. It consists in blocking Internet resources offering the purchase of fake insurance policies. In the last two months of this year alone, law enforcement officers have managed to block three hundred such sites.

Despite the active counteraction to fraud, the introduction of new methods of combating it, there are many who want to enrich themselves at the expense of insurance. Only an increase in the legal culture of citizens and an improvement in the standard of living of the population can minimize the criminal activity of fraudsters.