Types of Most Common Insurance Frauds by Individuals

by siteadmin
August 8, 2023

Types of Most Common Insurance Frauds by Individuals

Insurance, without a doubt, represents an integral safeguard in our lives. From our health and homes to our vehicles, it forms a financial safety net that shields us from unexpected adversities. However, not everyone plays by the rules. In fact, according to the FBI, the total cost of insurance fraud (excluding health insurance) in the United States is estimated to be more than $40 billion per year. This means that insurance fraud costs the average U.S. family between $400 and $700 per year in increased premiums.

These staggering figures highlight an insidious problem: insurance fraud. By exploiting the system, some unscrupulous individuals inflate insurance costs for everyone. This practice leads to significant losses for insurance companies and translates into higher premiums for honest policyholders. In this blog, we will delve into some of the most prevalent types of insurance fraud committed by individuals, providing you with a comprehensive understanding of this pervasive issue. This knowledge can arm you with the information you need to spot and steer clear of such dishonest practices.

1) Staged Accidents

Regrettably, the phenomenon of orchestrated car accidents is escalating alarmingly. Crafted by fraudsters aiming to capitalize on insurance settlements, these fabricated incidents pose a double threat – potential physical harm and financial loss to unsuspecting drivers. The Insurance Research Council estimates that fraud and buildup added between $5.6 billion and $7.7 billion in excess payments to auto injury claims in 2012. Therefore, it's essential to stay vigilant while on the road and not hesitate to inform the authorities about any dubious activities you might notice.

2) Exaggerated Damages

Accurate reporting of vehicular damages is crucial in the aftermath of an accident. Yet, some individuals manipulate this necessity by grossly overstating the extent of damages, hoping to secure a more substantial insurance settlement. According to a report from the Insurance Information Institute, these fraudulent claims can amount to 10% of claim costs under certain lines of insurance, subsequently driving up premiums for everyone. Hence, maintaining integrity and transparency about accident-related damages becomes imperative not just for individual policyholders but for the stability of the insurance landscape as a whole.

3) Faking Injuries

Regrettably, the insurance landscape is tarnished by individuals who master the art of deception to benefit from personal injury claims. The act may even extend to concocting injuries to illicitly profit from the situation. The Coalition Against Insurance Fraud estimates that fraud steals $80 billion a year across all lines of insurance. Such acts not only inflate insurance expenses but also contribute to a surge in fraudulent claims, thus complicating and delaying the processing of genuine claims.

4) False Claims

Historically, individuals have been lodging counterfeit insurance claims with diverse motivations, most frequently to secure a payout for a nonexistent event or loss. This breaches the law and negatively impacts insurance companies, resulting in a domino effect that burdens honest policyholders.

5) Misleading Information

In an attempt to procure lower premiums, some individuals resort to providing misleading information during their insurance application process. This could involve falsifying details about one's driving history or the nature of the insured asset, such as the type of vehicle. According to the National Insurance Crime Bureau, application fraud is one of the most prevalent types of insurance fraud. Although it may appear to offer short-term financial relief, the discovery of such deceit can result in escalated costs in the long run, along with potential legal consequences.

Home Insurance Frauds Examples

Inflated Claims: A policyholder might exaggerate the extent of damage to their home after a legitimate incident, like a fire or storm, to receive a larger payout.

False Claims: Homeowners might report thefts that never occurred, or claim for high-value items they never owned.

Intentional Damage or Arson: Some homeowners might intentionally damage their property, or even commit arson, then file a claim as if the incident was accidental.

Unoccupied Property Fraud: This involves a homeowner insuring a property as their primary residence when it's actually vacant or used as a rental property.

Health Insurance Frauds Examples

False Billing: Healthcare providers may bill for medical services, procedures, or equipment that were never actually provided.

Upcoding: This involves healthcare providers billing for a more expensive service than was actually rendered.

Unbundling: Providers list multiple components of a procedure separately, instead of using the correct bundled code for the entire procedure, resulting in a higher bill.

Phantom Patients: Billing for treatments or procedures for patients that do not exist.

Examples of Car Insurance Frauds

Staged Accidents: This involves individuals deliberately causing a car accident, then making a claim for damage or injury.

Fronting: This is when a higher-risk driver, such as a young person, is added as a named driver to a policy, when in fact they are the main driver, to get a cheaper premium.

False Registration: Registering the car in a location with lower insurance rates, even though the car is primarily kept and used somewhere else.

Car Theft Fraud: This happens when a vehicle owner falsely reports their car as stolen to collect the insurance payout, while the car may be hidden, sold, or even destroyed by the owner.

Exaggerated Damage: After a legitimate accident, a car owner might exaggerate the extent of damage to their vehicle to receive a larger payout.

Top 10 Insurance Frauds / Insurance Frauds Examples

Insurance fraud is a global issue affecting many different areas. Here are ten prominent insurance fraud cases from around the world, highlighting the variety and severity of these crimes:

Ghost Broker Scam, UK (2011): A large-scale operation where fraudsters sold nonexistent car insurance policies, causing victims to drive illegally without insurance.

Kansei Group's Fake Death Claims, Japan (2000): Over $1 billion was swindled in life insurance by faking the death of policyholders.

Workers' Compensation Scam, California (2014): A $500 million scam involving numerous health practitioners providing unnecessary treatments and fraudulent claims.

Martin Frankel's Stolen Insurance Company Assets, USA (1999): Frankel defrauded insurance companies out of more than $200 million, using the money to support his extravagant lifestyle.

Yongcheng Coal Case, China (2020): An $18.7 million life insurance fraud involving faked deaths and false claims to exploit insurance policy loopholes.

Transneft Oil Pipeline Fraud, Russia (2009): Over $4 billion siphoned off through fake insurance policies and construction contracts.

HealthSouth Corporation Fraud, USA (2003): The CEO and other executives inflated company earnings by $1.4 billion to meet stockholder expectations, in part through fraudulent insurance claims.

Michael "Mickey" Segal's Near North National Group, USA (2004): Segal misappropriated over $30 million in insurance premiums from his brokerage's trust fund.

Accident Assistance Scam, UK (2011): Fraudsters staged car crashes to claim millions in insurance money.

Recheio Cargo Theft, Brazil (2017): A series of fictitious robbery reports to collect insurance for the "stolen" goods, costing insurers millions.

Please note that while the above cases are notable, insurance fraud frequently occurs on a smaller scale and affects all types of insurance, including auto, home, life, and health insurance.

Insurance Frauds Punishment

The consequences of insurance fraud can be quite severe and vary depending on the jurisdiction and the nature of the fraud committed. Punishments may include:

Fines: Convicted fraudsters can be subject to significant financial penalties, often much higher than the amount they attempted to fraudulently claim.

Imprisonment: More severe or repeat offenses may lead to prison sentences. The length of the sentence can vary widely depending on the scale of the fraud, but it can be several years for serious offences.

Probation: In some cases, individuals convicted of insurance fraud may be sentenced to probation, requiring them to meet certain conditions, such as regular check-ins with a probation officer, attending counseling or classes, or performing community service.

Restitution: Courts often order those convicted of insurance fraud to pay restitution, meaning they must repay the money they stole to the insurance company.

Revocation of License: If the fraudster is a professional (such as a doctor or lawyer) or a business, they could lose their professional license or business license.

Increased Insurance Premiums: Individuals who commit insurance fraud may face higher insurance premiums in the future, if they can obtain insurance at all.

Civil Lawsuits: In addition to criminal charges, fraudsters can also face civil lawsuits from the harmed parties seeking compensation for damages.

Criminal Record: A conviction will result in a permanent criminal record, which can impact many aspects of life, including employment opportunities.

Remember, insurance fraud is a crime and the repercussions are severe. It's always better to be honest and upfront with your insurance provider.

FAQs

Who usually commits insurance fraud?

Many individuals, including policyholders, insurance company employees, or third parties such as healthcare providers or auto repair shop owners can commit insurance fraud. It's not limited to any specific demographic or socio-economic group. Anyone who makes false claims to an insurance company to gain financial benefits can be guilty of committing insurance fraud.

What is the largest area of fraud in insurance?

Health insurance fraud is one of the most extensive areas of fraud. It includes billing for services not rendered, duplicate submission of a claim for the same service, misrepresenting procedures performed to obtain payment for non-covered services, and exaggerating services rendered. It's estimated that fraud accounts for up to 10% of total healthcare spending in the U.S.

What is an example of fraudulence?

An example of fraudulence in the insurance sector could be someone staging a car accident or injury that didn't really happen in order to claim money from an auto or health insurance company. Another example might be a healthcare provider billing an insurance company for medical services that they didn't provide to the patient.

What is impersonation in insurance?

Impersonation in insurance is when someone pretends to be someone else to gain insurance benefits. This could be a case where an individual assumes the identity of another to take out a policy in their name or uses another's information to claim benefits from an existing policy. This is a type of identity theft and is considered a serious crime.

Conclusion:

Insurance fraud is a serious crime that affects everyone. By knowing the most common types of fraud individuals commit, you can protect yourself and your policy. It's important to always be honest and upfront when dealing with insurance, and to report any suspicious behavior. Together, we can all help prevent insurance fraud from impacting honest policyholders.

Types of Most Common Insurance Frauds by Individuals Insurance, without a doubt, represents an integral safeguard in our lives. From our health and homes to our vehicles, it forms a financial safety net that shields us from unexpected adversities. However, not everyone plays by the rules. In fact, according to the FBI, the total cost…