Insurance fraud detection methods

 
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With trahovanie - an area to which traditionally attracted public attention. If voluntary life, property or civil liability insurance remains a private matter of a company or a citizen, then the situation with compulsory insurance, when the policyholder cannot avoid the need to conclude a contract, requires attention to all moments when, as a result of insurance fraud, a citizen or company does not receive the funds due to them. insurance payment. Methods for identifying such situations are relevant for policyholders, government authorities - regulators.

Types of insurance fraud

Failure to receive insurance compensation due to the fact that an insurance company operates without a license or was originally created for fraudulent purposes is not the most striking example of actions that are followed by criminal prosecution. Insurance companies are also not immune to the risk of being scammed. Especially often, citizens and legal entities seek to illegally seize the funds of insurers when realizing the opportunities provided for in OSAGO. Immediately after the adoption of the law on compulsory insurance, the Russian Union of Auto Insurers developed the Concept of Organizing Interaction between Insurance Organizations to Combat Fraud and Other Offenses in Auto Insurance, which was planned to be implemented sometime before 2005. The document provided for:

  • reducing the unprofitableness of the insurance business by increasing the degree of interaction with the investigating authorities to identify and investigate insurance fraud;
  • strengthening cooperation in order to develop more effective legal prosecution of this type of crime;
  • organization of cooperation and assistance to insurance companies affected by fraud;
  • interaction with international organizations operating in this area.

As a result of the commission's activities, amendments were made to the Criminal Code in 2012, and Article 159.5 of the Criminal Code of the Russian Federation "Fraud in the field of insurance" appeared, in which the composition was deciphered as follows:

  • theft of other people's property by staging the circumstances of the insured event or overstating the amount of losses;
  • the same act committed by a group of persons.

The practice of the foreign and Russian insurance market has developed several standard methods of insurance fraud. When analyzed, they are clearly divided into two groups:

  • crimes against the insurer;
  • crimes against the policyholder.

In the first case, when the damage is caused to the insurance company, either employees (insiders) or customers are the culprit. In the second case, the circle of organizers of the crime is not limited to the companies themselves or their employees. There are also insurance brokers or persons creating fictitious insurance organizations. If we identify specific elements of crimes provided for by the Criminal Code, then almost all the contents of the economic block are typed:

  • fraud;
  • abuse of power;
  • bribe;
  • forgery;
  • misappropriation or waste;
  • giving or receiving a bribe;
  • pseudo-business.

Crimes of the nature of insurance fraud are committed against the insurer. And here is an interesting statistics that divides offenses by the area in which insurance is carried out:

  • 62% of cases are car insurance fraud;
  • only 10.2% are offenses related to life and health insurance;
  • 22% - all other types of property insurance.

From the point of view of financial benefits, two points stand out: either the policyholders overestimate the amount of losses, or the same risk is insured twice. Each of the moments requires its own methods of identifying it.

But the problem is that insurance fraud is not limited to economic delinquency. As practice shows, crimes against the life and health of citizens can be aimed at illegal receipt of insurance payments. Investigators are confronted with murders committed for this very purpose, and they fall into three groups:

  • murder of the insured person, while the circumstances of the external insured event are carefully staged;
  • murder disguised as an accident;
  • murder of a person similar in anthropological characteristics to the insured person in order to pass him off as the policyholder.

Such cases are rare, in Russia they do not constitute a system, as in other countries where life insurance is more common, but they do exist.

Insurance Fraud Subjects

Two groups of persons most often become the subjects of fraud:

  • insurance companies or their employees offering insurance services without intending to make payments in cases stipulated by law or contract;
  • citizens and legal entities creating independently insured events with the intention only to receive an insurance payment. An example of such a situation would be the arson of property accepted for storage and wasted.

In each of the situations, the subject of the fraud seeks to benefit from an act committed with a single selfish purpose. Such actions may be accompanied by other elements of crime, for example, forgery, forgery of documents, deliberate damage to property. If in the first case the activity of the regulator, the Central Bank, helped to reduce the number of insurance frauds, then in the second case the level of risk does not decrease.

Companies at risk

Entrepreneurs entering into relationships with insurance companies should understand that the conclusion of an insurance contract is not always able to fully protect the property. Insurers may find a way not to pay money or significantly underestimate the amount of compensation, but it is difficult to identify the composition of insurance fraud in these acts. But the courts are overwhelmed with cases that are related to causing damage to insurance companies working with OSAGO.

All criminals working in this area are divided into "amateurs" and "professionals."

The former act at their own peril and risk, an example is the self-setting fire of an insured village house. Any company can suffer from their activities. Also, amateurs can collude with the employees of the insurance company and turn one insured event into several, receiving compensation for each. This type of fraud is not possible without the indulgence of the insurer's employees.

The latter work on a systematic basis with insurance organizations operating in many regions and specializing in insurance. Criminal communities with distributed roles are formed: someone is looking for clients, someone is playing the role of a fictitious emergency commissioner. Often one or more employees of the insurance company itself are in such a group. She also has serious connections in law enforcement agencies. A client from among vehicle owners does not have to persuade for a long time - it does not seem shameful to deceive the insurer for many motorists who feel like victims of unfair extortions in the form of OSAGO, payments for which almost never cover real damage.

Their activities are more strictly qualified by the criminal law, but it is more difficult to detect these crimes, thanks to the systematic connections of the organized group and experience with standard methods of detecting insurance fraud.

Detection methods

The application of one method or another is based on the capabilities of each participant in the insurance turnover. It is clear that a legal adviser of a small company studying an insurance contract has significantly fewer such opportunities than an employee of the bodies of inquiry or investigation acting at the moment when the committed fraud has already become the subject of investigation. When studying the situation in the case of OSAGO, the insurance company has very little time, it needs to pay compensation within a controlled time frame, with CASCO the time to study the circumstances of the insured event may turn out to be significantly longer.
Only the study of documents related to a specific insured event does not exhaust all the possibilities of organizational methods.

Technical and software detection methods

Technical and software methods for detecting insurance fraud work best in the field of civil liability insurance in identifying those accidents that were designed only for the purpose of embezzling funds from insurance companies. Security services should have in their arsenal technologies that allow using programming methods or physical changes to fully reconstruct events occurring at a specific accident site. A certain block of such technologies has been adopted by the US National Center for Analysis of Automobile Accidents, but domestic insurers also use them. The software product developed for this purpose is expensive, and its efficient operation is complicated by the lack of specialized libraries, which include the geometric data of cars used in Russia, both domestic and foreign, developed for the Russian market.

It is necessary to develop domestic software products that could:

  • project the expected deformation of the vehicle in a specific collision;
  • calculate the trajectory of vehicles at the moment of collision, determine possible damage;
  • have two levels of information processing, on the first of which the accident circumstances will be reconstructed by engineering methods, on the second the parameters of interaction of vehicle structures from the point of view of physical laws will be calculated.

To implement such a software product, it is necessary to create a data library that includes all the parameters of cars that go on Russian roads. But she, in the presence of competent and trained personnel, will be able to almost completely exclude cases of payment of insurance compensation for deliberately created road accidents. The use of a program of domestic development will make it possible to legitimize its conclusions to a greater extent, since the data offered by foreign software products will be skeptically perceived by the Russian judicial authorities.

Rapid detection methods

Rapid methods of detecting insurance fraud are available not only to the bodies of inquiry. Sometimes it makes sense for a legal entity, an insurance company to involve a company providing professional services in the field of security for cooperation. Departure of a specialist to the scene of an accident should be accompanied by the use of technical means that will help fix the evidence base. Among them:

  • photography;
  • study of photos sent by the client using ExifTool, which make it possible to accurately reconstruct the circumstances of the event;
  • traceological examination;
  • reconstruction of the scene;
  • examination, for example, fingerprinting. It is used for staged theft of elements of a car; fraudsters sometimes forget to erase their fingerprints.

So, often traces of an accident are applied to a car submitted for examination using plasticine, and they can be found. Even in a situation of lack of time and having a refusal to initiate a criminal case on hand, it can be challenged due to inaccuracies in the design and the period during which fraud can be established can be extended. If it is again denied, this is again contested, and this organizational method of denying payment helps to extend the period of denials until the statute of limitations expires.

The pursuit of insurance fraud requires regular security personnel on the company's staff. Studying current court practice can also help identify difficult situations in the company's activities that are similar to insurance fraud.