insurance::fraudulent-claim

Fraudulent Claim

A claim submitted with deliberate misrepresentation or concealment of material facts to obtain an unentitled payment.

Canonical Definition

A fraudulent claim is an insurance claim in which the claimant knowingly makes a false statement, conceals material information, or deliberately exaggerates a legitimate loss with the intent of obtaining a payment to which they are not entitled. Fraud may be opportunistic (exaggerating a genuine loss) or organised (staged accidents, fabricated incidents). Insurers are required under applicable law and regulatory guidance to maintain anti-fraud controls and to report suspected fraud to relevant authorities. A policy may be voided in its entirety upon discovery of fraud. Source: Insurance Europe Anti-Fraud Guidance; IAIS Insurance Core Principles ICP 19; UK Fraud Act 2006.