Policyholders damage insurers by five percent of the premium annually through various lies. The crisis has ‘awakened’ even more fraudsters, but insurers are increasingly able to expose them and initiate appropriate legal proceedings.
writes Tatjana Brebrić
[email protected]
Taking a knife, an axe, or any other cold weapon within reach and using it to injure oneself is unimaginable for most people. Doing something like that to obtain money from insurance, most would agree, is on the brink of madness. Nevertheless, even in Croatia, there are such examples.
– We have had cases where policyholders intentionally caused a fire, and certainly the most bizarre was the case of a policyholder who cut off his own finger trying to claim damages under his accident insurance policy – explains Iris Urem from Triglav Insurance.
As with all insurers in Croatia, the most common attempts at fraud at Triglav are less drastic, occurring in property insurance cases, primarily automobile insurance. The reason is self-evident since auto liability policies make up the majority of the market, leading to the most frequent attempts at fraud.
Footballers on Crutches
– Fraud also occurs in vehicle insurance, with the most common examples being traffic accidents that did not happen as described in the damage report – confirm those at Generali Insurance. Thus, most fraudsters will try to spare their limbs and attempt to ‘extract’ money from insurers through less painful means, such as the bumper of their car. Therefore, some of the most common examples of fraud are related to property.
Detective Assistance
– The service of a detective agency is one option, but we mainly rely on the expertise and experience of the claims department staff. In our company, we have developed mechanisms and procedures that show significant results in detecting attempts at fraud – explain those at Uniqua Insurance. Most companies rely on the education and expertise of claims handlers, but in some cases, additional help is simply necessary.
– The services of detective agencies are applied when there is suspicion of attempted fraud, especially for larger claims, or in cases of theft and fraud – explain those at Velebit Insurance. The same is true at Basler Insurance Zagreb, which uses the services of detective agencies only in cases where there is established reasonable suspicion of attempted fraud during the claims process.
– In property insurance, the most common frauds are: intentional arson and over-insurance of property and equipment, staged burglary thefts, staged vehicle collisions under mandatory automobile liability insurance and comprehensive insurance, concealing previous illnesses when concluding life insurance contracts, and falsified medical documentation in accident insurance claims. In addition to the aforementioned examples of the most common frauds, there is also the method of presenting significantly higher damages than those actually caused by the insured event – explain those at Grawe.
It seems, therefore, that situations from movies where a participant in a traffic accident arrives in court with a neck brace and crutches and tries to ‘swindle’ the insurer, only to play football 25 minutes later on the other side of town – are still not so common, although certainly not unbelievable for insurance companies in Croatia. Insurers agree that the difficult economic situation contributes to this, as the number of attempted frauds increases with the severity of the economic crisis.
From Suspicion to Punishment
– The situation we are in certainly contributes to the market recently recording an increase in reports of fraudulent claims in insurance. From global and European experiences, it is estimated that fraud accounts for about two to five percent of the total premium in the insurance market. According to our analyses, Allianz has similar indicators. For example, we currently have 17 criminal charges filed against individuals we have determined attempted to fraudulently obtain compensation – confirms Sonja Miočić from Allianz. It is difficult to assess the exact data and how many frauds occur annually, but it seems that through various lies, policyholders manage to defraud insurers by five percent of the premium. – The share of attempted frauds and executed frauds is quite difficult to estimate, as a reference figure for all insurance companies in Croatia is around 200 million kuna per year, and in the past five years, there have only been three final convictions for the crime of fraud in insurance. Regardless of the data presented, the trend is an increase in attempted frauds during crisis years – agree those at Velebit Insurance. On the other hand, it is certain that there is a tendency for the number of cases that insurers manage to prove as fraud or attempted abuse of insurance to increase. – While we could only suspect before, we are now increasingly able to prove such cases and initiate appropriate legal proceedings. Traffic police stations have actively engaged in fraud detection activities, and technological advancements allow traffic experts to simulate the dynamics of damage occurrence and accurately determine the existence of a causal link between the event and vehicle damage. The computerization of the health insurance system facilitates the detection of abuse of medical documentation, which was previously a lengthy and complicated process – explains Jasmina Müller from Uniqa Insurance.
