Insurance fraud

Apply for SearchInform DLP TRY NOW

M oshennichestvo in the insurance industry, various schemes of fraud on payments inhibit the development of the domestic insurance market and reduce the overall performance of the economy.

According to statistics from the Russian Union of Insurance Companies, the total volume of insurance payments over the past two years amounted to 211 billion rubles. The attackers received 10% of the amount, i.e. 21 billion. This amount included all cases of insurance payments, the legality of which the insurers failed to challenge.

Why are there more cases of insurance fraud?

Despite the significant amounts of insurance compensation that fall into the hands of swindlers, it is possible to prove the fact of fraud only in 1% of cases. The situation is due to a minimum of circumstances:

  • in fraud schemes, especially with forgery of documents, employees of insurance organizations and law enforcement agencies are often involved;
  • the level of legal awareness of citizens remains at a low level. Loyalty to insurance policy scams is due to mistrust in the work of the insurance companies themselves, most of the malefactors are not aware of the crime and minimize the significance of the acts.

A poll conducted by the Russian Union of Insurers showed that 30% of citizens are sure that employees of the insurance sector are initially aimed at deceiving customers. Therefore, policyholders do not see a crime in overstating the amount of losses on insurance payments.

Fraud schemes

The scheme of deceiving insurance compensation seems to be simple, which provokes fraud. Corruption in law enforcement and mistrust of insurance companies also contribute to an increase in fraud. The most common car insurance scams are considered. This group of incidents is conventionally divided into three types of schemes:

  • fraud in the implementation of insurance policies;
  • deliberate increase in damage from road accidents;
  • complex schemes carried out by criminal groups.

· Sale invalid policy

Unscrupulous insurance agents, wanting to make illegal profits, sell genuine policy forms at a lower cost. According to documents in the company, such forms are recognized as lost or damaged, and are considered invalid. It is impossible to receive a payment on such a policy. Upon establishing the fact of fraud, unscrupulous insurance agents are prosecuted in accordance with the Criminal Code.

· Re-insurance

Repeated or multiple insurance involves the simultaneous issuance of policies in various insurance organizations in order to receive payments for a rigged accident in all insurers.

· Insurance damaged cars

A common fraud scheme, the essence of which is that a car with serious damage or defects is insured as safe and sound. In such a situation, two options are possible: the owner of the car hid the damage from the insurance agent or entered into a criminal conspiracy with him. This type of fraud accounts for up to 80% of all car insurance incidents.

· Hiding drunk drivers

An accident that occurred due to the fault of a drunk driver is not recognized as an insured event and policy payments are not made. There are two ways to hide the drunken state of a driver: swap places with a spouse who is sober and entered into an insurance policy, or collude with a traffic police officer.

· Oversize damage

The majority of insured drivers want to increase the amount of payment in case of an accident. There is a re-payment scheme in which the driver receives compensation from the perpetrator of the accident on the spot, and then takes a certificate from the traffic police that the perpetrator of the accident is unknown. By submitting such a certificate to the insurance company, the victim receives a second compensation. Such actions are recognized as fraud and involve liability in the form of a fine or imprisonment.

· Mock accident

Such fraud is aimed at staging an accident and damaging a part of the car that was damaged in a previous accident, which was not recognized as an insured event. A scam like this requires a group of attackers, which includes law enforcement officers. Most often, the participants in the scheme stage a collision of a car with a tree. After - they negotiate with a familiar driver who agrees to provide his car and become the "culprit" of the accident, as well as with the traffic police officer who registers the accident.

Experienced insurance agents, having gone to an accident, immediately notice that the accident is rigged. Such cases are contested by insurance companies in court.

· Rigged hijacking

Fictitious accidents and rigged thefts are the main sources of losses for insurance companies. It is rarely possible to find a car when stolen: most often in 99% of cases, the car is immediately disassembled for parts and sold. Disassembled, the car is a pile of scrap metal that can be stored for a long time in the garage or utility room. Dishonest car owners try to use such a fraudulent scheme. However, it is rarely possible to deceive insurance employees, since such schemes are well studied.

Attempts to cheat motorists are part of the routine for insurance agents. Constantly confronted with scams, agents, when leaving for an accident, closely study the details of the accident, interview witnesses, inspect the car, double-check the scheme drawn up by the traffic police. Insurance agents conduct their own investigation of the incident, especially in the absence of the person responsible for the accident or witnesses. Such actions are completely legal. In accordance with the Federal Law "On Insurance", insurers have the right to submit inquiries to banks, law enforcement agencies, medical institutions and independently find out the reasons and circumstances of insured events.

· Fraud in the field of personal insurance

Scams on the part of insured persons involve contacting an insurance company after an injury. Such fraud schemes are often successful, as it is extremely difficult to determine the time of the injury that caused the deterioration of health, moreover, a certificate from a doctor is enough to receive insurance compensation for a fracture, dislocation or neuralgia. Other fraudsters self-injure themselves in order to obtain compensation from the insurance company.

Some clients, knowing about a serious illness, conclude an insurance contract, hiding this fact. And after a while, they declare the discovery of an incurable disease and claim an insurance payment.

· Travel insurance

There are two popular scam schemes among scammers. The first is that the insured tourist negotiates with a foreign doctor, who draws up documents on the "performed" treatment. Upon returning home, the tourist applies to the insurance company and receives compensation.

The second scheme involves travel agency employees who transfer information about tourist policies to foreign doctors. Foreign doctors forge documents on the performed medical procedures, the payment of which is entrusted to the insurance company.

· Scams in the area of property insurance

Fraudsters take out insurance for property that does not exist. The subject of insurance is borrowed for a while or fake documents are provided to the insurance organization. Other swindlers deliberately inflate the price of the insured property. Still others, by analogy with a car policy, insure the same property in different insurance companies. Fraudulently insured property is destroyed, for example, in a fire or robbery. Such acts fall under Article 159 of the Criminal Code “Fraud”.

Schemes of cheating employees of the insurance

Dishonest employees of insurance companies are also not uncommon. They offer clients to conclude a personal insurance contract, thanks to which they will be able to save money for old age, and in case of death, the accumulated funds will be received by the relative specified in the contract. The deception consists in the fact that the client fills out and signs the application, transfers the initial payment, but does not immediately receive the documents from the insurer. After receiving the contract, unpleasant news opens: the amount of the monthly payment is higher than it was agreed. And compensation is provided only for death from an accident. If the insured person dies due to illness or heart attack, no benefits are payable.

How to counter insurance scams

A preventive measure in the fight against fraud was the exchange of information between insurance companies about the policies sold. Initiated and led the exchange of information by the Russian Union of Insurers. Four years ago, the Union formed the Bureau of Insurance Histories, which brings together insurance firms to collaborate to prevent insurance fraud.

Law enforcement agencies began to pay increased attention to such criminal offenses. If in 2013-2014 1% of the incidents detected reached the court, then in 2018 there were judicial precedents and sentences that came into force to fraudsters who tried to fraudulently obtain insurance payments.

Also, the efforts of insurers are aimed at blocking the activities of Internet resources on which counterfeit policies or blank forms of insurance certificates are sold. Through the joint efforts of insurers in 2016-2017, it was possible to suspend the work of 300 such sites.

Another way for the insurance company to avoid losses from fraud is to include the amount of damage in the cost of the policy. However, such a policy negatively affects the insurance company itself, since the increase in tariffs scares off customers and lowers the rating.

The most effective way to combat fraud is to establish an insurance incident investigation department in the staff of each insurer. Specialists are most often recruited from former law enforcement and security professionals.