Insurance is based on the principle of mutual benefit and is designed to protect against uncertain and insurable loss.  Unsurprisingly, there are those who wish to undermine this principle for their own financial benefit.

The term “insurance fraud” covers a range of issues and can be deceiving to some people.  Put simply, fraud is another form of theft which involves some form of trick or deception, or both.

Insurance fraud can include the exaggeration of otherwise legitimate claims, an intentional misrepresentation of the facts or a complex organised manipulation of the claims process to gain a financial benefit where there has been no actual or insurable loss.

The most common form of insurance fraud is the exaggeration of personal claims - this is often referred to as opportunistic fraud.  Premeditated or planned frauds are also common and are usually, but not always, committed by serial claimants, professional fraudsters and / or organised criminal groups.

The ability to make a timely and informed decision on a claim is a challenge faced by all insurers.  Insurers seldom have the time or resources required to conduct enquiries on each and every claim, which often results in the settlement of fraudulent claims.  Fraudulent claims account for a significant portion of all claims received by insurers and are estimated to cost billions of dollars annually.

Regardless of whether the fraud is committed on a one-off basis or is a series of frauds, it is still considered at law to be a serious indictable offence where the penalties can be imprisonment or a substantial fine, or both.

At QNA, we offer tailored solutions to assist insurers determine the circumstances of a claimed loss, and also, issues pertaining to coverage and liability.  Additionally, our solutions assist insurers separate the legitimate claims from the fraudulent ones.  Irrespective of any perceived issues with a claim, we deliver unparalleled ethics and expertise during every investigation.

For further information, please call us on + 61 2 9212 5000 or write to us here.