Insurances go harder against fraudsters

Insurance fraud

Innocent targeted by insurance companies

Insurances go harder against fraudsters

Insurance companies take tougher action against fraudsters. Companies have to be careful, because innocent people can quickly be targeted as well.

Insurance fraud is a real popular sport, claim the insurance companies. Which is why they suspect persons. Vehicles – often hastily – into the anti-fraud file. But they may have lost their sense of proportion. Michael Weber of the Institute for Accident Analysis warns: "In some cases, claimants are accused of fraud because they did not declare previous damage after an accident – but they did not even know about it because it was caused by the previous owner.

The search for black sheep is intensified

The Association of Insured People (BDV) also takes a critical view of the procedure. The issue is artificially inflated. "Innocent people must not be placed under general suspicion", says BDV board member Axel Kleinlein. In the course of a revision of the anti-fraud file, which was supposed to serve data protection, the search for black sheep was intensified at the same time. This is how more unlucky people with frequent damage find themselves on the blacklist.

In private liability, home contents and residential buildings insurance, for example, insurance companies write customers into the information system (HIS) as soon as they report three claims within 24 months. In motor vehicle and legal protection insurance, the threshold is somewhat higher, with four claims in twelve months. This is intended to strengthen the defense against fraud, the GDV working group on property crime justifies the new rules.

Informa Insurance manages the anti-fraud file

In the car insurance, however, not only every vehicle theft and every total loss is reported, even in the case of fictitious settlement on the basis of an expert opinion, one must reckon with an entry. An example: Insurance employee Jan Meder (name changed) processes the accident claim of an Audi A6. Round 8.000 euros for the graze damage on the driver's side. The damaged party wants to repair the damage itself. Claims compensation on the basis of an expert's report on damages. So far, so good.

However, in the case of fictitiously settled claims, the vehicle identification number may now be reported to the HIS if a certain amount of compensation is exceeded. What Meder promptly settles. At the urging of data protectionists, the newly founded Informa Insurance manages the data. Is now organized according to current data protection. So the new anti-fraud file should not only be more transparent, but also faster. Therefore, claims handler Arnold Schwarz (name changed) lands a hit when he receives an 8.000 euros worth of graze damage to an Audi A6: Not only has the car been reported by another insurer, it appears to have the same damage again. The entrepreneur wanted to cash in twice!

In case of fraud, company car drivers risk their jobs

In the future, even accident witnesses may be stored in the HIS if they have once been found guilty of fraud. "Often, these offenders are part of an "autobummer ring", explains Thomas Lämmrich of the German Insurance Association (GDV). The same people appeared sometimes as drivers, sometimes as claimants or as witnesses. Another typical scam is alleged wheelbarrow or bicycle collisions with a car, which in fact result from a self-inflicted accident. Cheating company car drivers risk their jobs. This is how a company in Frankfurt uncovered an employee who unlawfully paid 2.000 euros in damages had been collected. The boss forced the employee to resign himself – completely legally, as the labor court ruled (ref.: 9 Ca 7095/04).

Fleet managers should consider whether they also cover the misappropriation risk of company cars. "In the normal hull insurance embezzlement is excluded, but a special agreement for companies is possible", says insurance broker Lutz Thermann. Alternatively, one could take out a fidelity policy for the company. According to GDV, insurance companies lose around four billion euros a year due to fraud. Ultimately have to pay through higher premiums. Therefore the HIS system serves quite the consumer protection.

Who is in the HIS, must expect more intense scrutiny

"In 30 percent of all fraud cases, the first clue comes from the HIS", says Lämmrich. That's why honest car owners may also be routinely entered into the HIS. A catalog of conspicuous features is to help against car hijacking gangs, for example if the damage picture according to the expert does not correspond to the description of the course of the accident. However, GDV wants to keep secret from which amount of damage a report is made, as well as the conspicuous features that entitle to a registration. "If we were to publish these criteria, we would be providing the perpetrators with a fraud manual", explains Lämmrich.

In addition, an entry in the HIS does not mean that the customer will no longer receive insurance in the future. However, the affected party must expect that the insurance industry will examine damages more intensively. Good to know: Storage without the knowledge of the insured person is no longer permitted. In the meantime, everyone can check free of charge whether he or his vehicle is on the black list. If there is a suspicion of fraud, you should act immediately. "If the insurer does not pay, it helps little to discuss with him", warns attorney Arno Schubach. Then those affected must have it legally examined whether possible incorrect information in the notice of claim was merely the result of negligence. If these errors do not affect the compensation at all, the insurer must pay. In case of gross negligence there is still a partial compensation. Legal expenses insurance usually covers the costs of lawyers to enforce justified claims.

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