Types of Insurance Fraud

The following is a list of the more commonly perpetrated acts or schemes of insurance fraud:

Auto

  • False or inflated theft repair claim
  • Owner “give up” (false stolen car report) “Jump in” (someone not in vehicle at time of accident)
  • Staged accident
  • Intentional damage claim
  • Falsifying the date or circumstances of an accident to get coverage
  • Rate evasion

Homeowner

  • False or inflated property damage
  • False or inflated burglary or theft report
  • Arson
  • Intentional damage claim

Health Care

  • Billing for services not provided
  • Billing for a more expensive service than what was actually provided
  • Providing and billing for unnecessary services while representing that the services were necessary
  • Double billing

Life & Disability

  • Fake death claims
  • Falsified beneficiary claims
  • Fake disability claim
  • Submission of forged documents to fraudulently continue a disability claim

Agent / Industry

  • Theft of premiums
  • Unlicensed and/or unauthorized activity
  • “Churning” – Falsifying information to a consumer in an effort to get them to use the cash value of an existing policy to buy a new, usually more expensive policy

Workers’ Compensation

  • Working while collecting workers’ compensation benefits
  • Faking injury
  • Claiming to be injured at work when injury occurred elsewhere
  • Employer under-reporting payroll and/or number of employees to obtain lower premium
  • Intentionally misclassifying employees’ job codes
  • Employer failing to carry workers’ compensation insurance