What is insurance fraud?
Simply put any activity or act that is a deliberate attempt to deceive an insurer to secure unfair or unlawful gain or deprive a victim of their legal right or recourse.
The National Association of Insurance Commissioners defines Insurance fraud as follows.
Insurance fraud occurs when an insurance company, agent, adjuster, or consumer commits a deliberate deception in order to obtain an illegitimate gain.
It can occur during the process of buying, using, selling, or underwriting insurance.
Insurance fraud may fall into different categories from individuals committing fraud against consumers to individuals committing fraud against insurance companies.
Insurance fraud, estimated at over a hundred billion dollars per year, not only imposes costs on insurance companies and threatens their competitiveness and future viability, but it is also financially damaging to consumers and detrimental to the economy and society as a whole.
Fraud is constantly evolving and affects all types of insurance.
The most common in terms of frequency and average cost are:
1. Automobile insurance, which is widely believed to be most affected by fraud;
2. Workers’ compensation committed by both employees and employers, especially during economic downturns and in high-risk industries;
3. Health insurance and medical fraud can be particularly costly, both financially and in actual loss of lives, due to the complexity and massiveness of the healthcare system.
What it means to us.
Insurance fraud is a problem that costs everyone. We take insurance fraud seriously.
Our agents are trained to identify attempts to defraud insurers and will work to prevent fraud in every encounter.
If you misrepresent yourself or when asked specific medical or health questions your response appears to display willful intent to defraud a carrier we will take note and inform the carrier.
What it means to you.
Insurance fraud is a problem across the United States, believed to be the second-largest white-collar crime in the country.
Often mistaken for a victimless crime, insurance fraud affects everyone by making insurance premiums more expensive for everyone.
Consumers should call their state insurance department if they suspect illegal activity or if they have questions before purchasing an insurance policy.
To deal with specific issues involving criminal activity, many state insurance departments have antifraud and criminal investigators, who work closely with federal, state, and local law enforcement officials to prosecute insurance fraud.
How you can help detect fraud.
Our experienced employees play a critical role in detecting cases of insurance fraud and information from citizens like you can be instrumental in helping us identify suspicious events surrounding a claim.
If you have reason to suspect insurance fraud, we encourage you to report your knowledge or observations by contacting us directly or your state’s insurance commissioner.
If you wish to file a consumer complaint you may do so via the Online Fraud Reporting System which is run by the National Association of Insurance Commissioners.
Additional information on insurance fraud can be found at www.insurancefraud.org.