Term
Insurance fraud
25 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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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
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Verisk study: AI image edits are accelerating digital insurance claims fraud
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AI editing tools linked to rising insurance fraud, Verisk reports
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Axle Teams With Experian to Bring Insurance Verification to Automotive Dealers to Reduce Fraud
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Techficient Launches Forthright: AI-Powered Fraud Detection Solution to Safeguard Insurance Distribution
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Exposing Fraud Faster With AI-Driven Open-Source Intelligence Solutions
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Zurich Strengthens Its Fraud Defences With Real-time AI, Connecting Industry-Wide Claims Data
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Sardine AI Raises $70M to Make Fraud and Compliance Teams More Productive
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Deepfake detection software helping insurers fight fraud
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Cyber Fraud Protect: Comprehensive Coverage Against Online Scams
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Roamly Launches Inspection Tool to Combat Insurance Fraud
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Zurich Malaysia Partners With GXBank To Launch Anti-Scam & Fraud Insurance
Showing the 24 most recent of 25.