What is Insurance Fraud?

What is Insurance Fraud?

Insurance Fraud is the deliberate falsification of information by a claimant in order to obtain a financial advantage or gain. Insurance Fraud ranges from overstating the value of damaged or lost items or not declaring information that is known and relevant to a claim, through to the activities of highly organised criminals coordinating large and complex false claims.
Insurance Fraud can be:

- Opportunistic – the padding and exaggeration of otherwise legitimate claims

- Premeditated – Arson, theft, staged incidents involving the fabrication of a claim

- Based on Non-Disclosure – Misrepresenting or hiding facts relevant to a claim
Insurance Fraud – A Victimless Crime?

Many in the community believe that insurance fraud is a victimless crime, that the only ones to suffer a loss are large faceless insurance companies.

In research carried out by the Insurance Council 25% of people interviewed claimed to know somebody who has committed insurance fraud, 20% endorsed the padding or exaggeration of an insurance claim and 38% believed that insurers can afford the cost and that there are no losers.

However, insurance fraud is a cost on the provision of insurance that ultimately contributes to the cost to members of the public through higher insurance premiums.
Getting Caught

Evidence in Australia suggests that up to 10-15% of claims exhibit fraud ‘indicators’.

Understandably insurers undertake sophisticated anti-fraud measures and will investigate activity believed to be fraudulent. Insurers work closely with law enforcement in each jurisdiction to ensure that appropriate action is taken when fraud is proven to have occurred.

The penalties for a fraud conviction may vary from State to State, but all are classified as serious indictable offences which can result in substantial custodial sentences if convicted.