Term
Insurance fraud
36 stories mention it
Insurance fraud is any deliberate deception used to obtain a payout or coverage from an insurer that the claimant is not entitled to.
In practice it happens at two points: when someone applies for a policy and misstates the risk to secure cheaper or broader cover, or when someone files a claim and misstates what happened, inflates the loss, or manufactures it outright, such as staging a collision or setting a deliberate fire. The claims team weighs the account against evidence — repair estimates, medical records, prior claims history — before paying out, and the cost of whatever slips through is spread across other policyholders' premiums.
The hard part is that most claims involve genuine uncertainty and honest people round in their own favor, so an insurer has to separate ordinary exaggeration from deliberate deception without treating legitimate claimants as suspects. Organized fraud is harder still, because a staged collision or a fabricated invoice is built to resemble a real one, and it often runs through a network of complicit intermediaries — repair shops, clinics, brokers — rather than one claimant acting alone.
Detection is a distinct product category built around this problem: software that flags edited or inconsistent photos, tools that cross-reference claims and policy data across insurers to surface patterns no single carrier would see alone, identity and document verification at quote or claim stage, and open-source and network analysis aimed at tracing rings rather than judging individual claims.
Written by Insurtech Daily.
For the running coverage rather than the definition, see the Insurance claims and underwriting hub.
Insurance fraud in the news
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Plymouth Rock Snags Awards at NJ Insurance Fraud Investigators Show
Insurer Plymouth Rock took home three awards at the New Jersey Special Investigators Association (NJSIA) annual insurance fraud conference recently. The NJSIA conference brings together special investigations units…
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Register: Risky Future AI Tools for Fraud Detection & Compliance ‘Demo Day’ on October 28
Insurance Journal’s Risky Future series is hosting the “AI Tools for Fraud Detection and Compliance” Demo Day, a series of free AI tool demonstrations designed exclusively for insurance carriers, SIU teams, compliance…
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Register: Risky Future AI Tools for Fraud Detection, Compliance ‘Demo Day’ on Oct. 28
Insurance Journal’s Risky Future series is hosting the “AI Tools for Fraud Detection and Compliance” Demo Day, a series of free AI tool demonstrations designed exclusively for insurance carriers, SIU teams, compliance…
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Register: Risky Future AI Tools for Fraud Detection & Compliance ‘Demo Day’ on October 28
Insurance Journal’s Risky Future series is hosting the “AI Tools for Fraud Detection and Compliance” Demo Day, a series of free AI tool demonstrations designed exclusively for insurance carriers, SIU teams, compliance…
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Bait house sting leads to roof fraud arrest in North Carolina
A roofing company employee is accused of damaging shingles on a staged home and reporting it as storm damage. The undercover operation was run by two insurers and state investigators.
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One fake death, four insurers: Data sharing exposes funeral fraud
A South African case shows why fraud invisible to single insurers shows up in shared data
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TDI Launches Fraud Task Force
The Texas Department of Insurance this week launched an insurance fraud task force that includes representatives from law enforcement, the insurance industry, consumer groups and other partners. The task force was…
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Vehicle Finance Fraud Now a $10.4B Industry: NICB
Sophisticated criminal networks are exploiting artificial intelligence and synthetic identities to target the multi-billion-dollar auto lending ecosystem, according to a new report by the National Insurance Crime…
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Auto finance fraud reaches $10.4 billion as criminals shift from theft: NICB
Synthetic identities, AI-faked pay stubs and fraudulent theft claims are driving a surge in auto lending fraud that increasingly reaches insurers.
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AI-assisted fraud is surging, and insurers are scrambling to keep up
AI-generated fake claims are outpacing industry defences, warn industry execs
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TN Funeral Director, North Carolina Man Charged in Insurance Fraud Investigations
A grand jury in Tennessee this week indicted a funeral home owner on insurance fraud, theft, elderly exploitation and abuse-of-a-corpse charges after a months-long probe by the Tennessee Bureau of Investigation.…
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Verisk releases Fraud Discovery platform connecting intelligence, analytics, and investigations
Verisk has announced Verisk Fraud Discovery, a fraud prevention platform that unifies fraud intelligence, advanced analytics, network analysis, digital media forensics, and case management into a single, scalable…
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Crif ships AI anti-fraud tool to tackle tampering during customer onboarding
CRIF – the global leader in credit and insurance information, analytics and solutions – has today launched its AI-powered fraud detection services in the UK, helping financial providers tackle tampering during customer…
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How a drugs trafficking probe unravelled a £300,000 insurance fraud
This £300,000 travel fraud was not caught by an insurer's claims team - it surfaced through an NCA drugs investigation, and that is precisely the problem IFED has been trying to address through cross-agency intelligence…
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‘Cockroaches in My Food’ Claim Leads to Insurance Fraud Charge
A Warren County, North Carolina man has been charged with insurance fraud for allegedly seeking an insurance payment from a restaurant where he claims he found cockroaches in his food. Investigators say it was one of…
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Why AI fraud tools could cause claim risks
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Japan: MS&AD insurers deploy AI image detection to combat fraud
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Ventura County DA Gets $900,000 to Combat Workers’ Comp Fraud
The Ventura County District Attorney’s Office was awarded $898,840 from to investigate prosecute workers’ compensation fraud for the fiscal year. The grant, awarded through the California Department of Insurance, funds…
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Louisiana Woman Arrested for Insurance Fraud Following Fire Investigation
The Louisiana Department of Insurance announced that a Monroe woman has been arrested for fraudulently obtaining insurance benefits following a residential fire. Tashira S. Glover, 42, allegedly submitted a homeowners…
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InsurTech NY: Pliant on Automating Payouts and Fighting Insurance Fraud with Virtual Cards
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Husband and Wife Insurance Brokers Sentenced for Fraud Scheme
A married couple from New Bedford, Massachusetts was sentenced yesterday for a scheme to defraud at least 50 individuals or insurance providers seeking insurance coverage through their business, BL Insurance Brokerage…
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Eight Sentenced in $1.2M Travel Insurance Fraud Scheme
Eight people have been sentenced to prison for their roles in a $1.2 million travel insurance fraud kickback scheme, the U.S. Attorney’s Office, Southern District of Indiana announced. According to court documents…
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Checking digital insurance fraud key to financial inclusion goals
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Mitek and Synectics Solutions Partner to Help UK Insurers Tackle Rising Digital Fraud While Expanding Fair Access to Insurance
Showing the 24 most recent of 36.