Fraud policy

General

Fraud damages the image of the insurance industry and in particular our own underwriting business. In addition, fraud has an undeniable influence on the claims burden and thus the result of our proxy portfolio.

In 2018, insurers demonstrated 12,879 cases of insurance fraud. Since the figures on this are kept by the Center for Combating Insurance Crime, this number has never been this high. With this successful approach to fraud, the sector achieved savings of 82 million euros in 2018. This means that over the past six years, more than half a billion euros have already been saved through effective action against perpetrators of fraud. As a result, honest customers do not have to pay for the financial damage these fraudsters have tried to cause.

It is the fourth year in a row that insurers have shown more fraud. In total, nearly 45,000 fraud signals were investigated in 2018. The increasing use of innovative fraud detection techniques, such as Artificial Intelligence, plays an important role in finding fraud signals. This increases the chance of being caught for those who think they can 'try it once'.

Apart from the direct damage caused by fraud, insurers spend a lot of time investigating and settling these types of cases. Simple fraudulent claims also cause damage, of which benevolent consumers ultimately bear the brunt. To avoid this, and to discourage potential fraudsters, insurers introduced a tit-for-tat approach in 2017. In this approach, a caught fraudster is presented with an invoice via SODA with a 'starting amount' of 532 euros. This is to compensate for the research costs incurred by the insurer internally. Since the start of this approach, more than two thousand cases have been handled in this way. This summer, the total amount paid by fraudsters passed the milestone of one million euros.

Top five insurance policies with the most fraud:

• Car insurance
• Contents and building insurance
• Liability insurance
• Package policy (combi insurance) -
• Travel insurance

This document was exported from the knowledge portal of eye Underwriting on 08-06-2022

The definition of fraud

The misuse of an insurance product or service by the policyholder or insured or beneficiary in order to obtain a benefit (in cash or in kind) to which one is not entitled.

Policy

It is the responsibility of the management to arrive at a good fraud policy and to ensure that appropriate measures are taken. We do not tolerate any form of fraud.

It is important that everyone within our company is familiar with the relevant aspects of fraud and that fraud awareness is promoted and supported by all employees.

Fraud prevention is a regular part of the day-to-day underwriting and claims handling process. In our procedures and instructions, we pay attention to detecting and monitoring aspects of fraud. Employees have been informed about research indicators and how they should be applied. In addition, every new insurance policy and every claim payment is checked against the CIS database.

The Fraud Control Track Book for the authorized agent and the score lists for research indicators and risk points are included in our Knowledge Portal and are available to our employees. Employees are aware of the contents of these documents. A suspicion of fraud is tested against the investigation indicators and risk points. This assessment is demonstrably recorded.
The general manager has been appointed as fraud contact person. In the event of an identified (possible) fraud, the general manager is immediately informed by the employee who identified it. The fraud contact person registers special registrations in the CIS database (including EVR registrations) that are signaled and any suspicion of fraud in the fraud register. Even if it eventually turns out that there has been no fraud, or if this cannot be proven. The fraud contact person is responsible for the confidential treatment of the fraud register.

If an EVR registration is detected or (a suspicion of) fraud is detected on a proxy insurance policy, the fraud contact person will inform the principal's fraud coordinator within 3 working days. Instructions of the principal are followed. 

We have laid down and explained our fraud policy on our website so that insured parties and other interested parties can take note of it.

In addition to the process checks we conduct on a daily basis, we provide a number of management checks to detect fraud afterwards.

If internal fraud is detected by us, we will act as stated in the Incidents Procedure. Fraud is always reported to the Ministry of Justice.