Such fraud attempts are not uncommon. And some are ready for anything. In Taiwan, a 21-year-old student intentionally cut off both his legs before simulating a car accident with an accomplice in order to receive nearly €2.5 million in compensation. But his legs, already necrotic when help arrived, intrigued the investigators. Not only did the student end up dead, but he was imprisoned for attempted insurance fraud.
Self-harm, cyclist betrayed by Facebook, soothsaying repairman, helmeted driver…: numerous unusual insurance fraud attempts
If the cases are extreme, the Assuralia federation confirms that the problem is not anecdotal for us. Each year, nearly 6,500 cases of proven fraud are detected. For an amount of nearly 155 million euros. Or €23,850 on average per file “But this is only the tip of the iceberg,” comments Nevert Degirmenci, spokesperson for Assuralia.
Erwig Rutten, Anti-fraud Advisor at Assuralia, confirms. “It is impossible to say precisely how many cases of fraud unfortunately slip through the cracks. Studies estimate that between 5 and 10% of compensation that is paid should not have been paid. But this is unverifiable. .”
Attempted insurance scam in La Louvière: “You’re a big liar”
Undue reimbursements which weigh on the community: it is in fact all policyholders who pay for these frauds. A bit like the price of yogurt which includes losses linked to shoplifting in supermarkets, the premiums that everyone pays each year also cover these insurance frauds.
Undetected fraud would represent between 400 and 800 million euros. Or between €35 and €70 per year per Belgian citizen.
Up to 5 years in prison and thousands of euros in fines!
But trying to cheat the insurer is not a good idea: When the private investigator mandated by the insurer becomes aware of facts which constitute an offense or a crime, he is obliged to notify the prosecutor of the King. Who can decide to take the fraudster to court. In correctional. Which can involve heavy penalties of up to 5 years in prison and thousands of euros in fines, in addition to procedural costs and penalties specific to each insurer.
Insurance companies attempted to demonstrate the existence of a criminal organization aiming to commit fraud in the province of Liège
And over time, claims managers – who can also be helped by IT tools – manage to detect attempted fraud of real claims declarations. “There are flashing lights, very characteristic alert criteria for attempted fraud,” says Roel Soetens. “It is, for example, astonishing the number of cats that cross in front of cars.”
However, the amount of the claim, contrary to popular belief, is not really an alert criterion. “You can have damage of €100,000, for example following floods, and be in good faith, confides Erwig Rutten. Just as you can declare a loss of €500 and it is suspicious. An affiliate who declares a loss of €500 € for the tenth time in two years will thus be more suspect than a person who has only declared a loss of €100,000 in 30 years.”
400 private detectives work for insurers
In the event of suspicion, it is up to the insurer to prove that the insured is attempting to commit fraud. “Basically, the insured must be considered to be in good faith, assures Roel Soetens. But there are alert criteria. And over time, the claims manager develops a flair for spotting attempts at fraud. Each company has its criteria and in case of doubt, it can appoint an investigator to verify the facts.
Of the 800 “private detectives” active in Belgium, around half work for insurers. And are responsible for checking whether or not there is attempted fraud. “But not all suspicious cases are necessarily investigated, explains Erwig Rutten. Firstly because a claims manager receives nearly 20 reports to process every day. Secondly because an investigation is expensive. When you launch an investigation for a loss of €700, we have many elements which suggest that we are dealing with an attempted fraud…”
In the event of fraud detected, in addition to the risk of imprisonment of the fraudster, the insurance may terminate the contract in question. “But he can also terminate all other contracts which linked the fraudster to the insurance. And fill in the RSR file which traces (Editor’s note: for 5 years) the history of each insured and which is shared between all insurers. This can increase the fraudster’s premium when he reinsured elsewhere.”
Ads to scam your insurance on Facebook!
According to Assuralia, domestic accidents, the intervention of pets and car claims constitute the main types of fraud. “There is also work accident fraud,” says Roel Soetens. “For example, with a football player who breaks his arm on Sunday, and pretends to fall down the stairs of his office the next day, to be covered by the insurance of his company.”
Or the one who multiplies accidents. On Facebook, for example, there are ads for intentionally crashing cars. On Facebook, an Internet user offers to create a “real car accident” for only 2,000 euros. “There are also cases that are too well documented. Like this person who had, in fact, taken photos of his valuables and weighed his gold just two days before a burglary. This is not necessarily proven fraud. But admit it that it’s suspicious. It’s bound to attract the attention of the disaster manager.”
