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Fraud case file examples

Personal Debt a Motive for Insurance Fraud

A man made claims 9 times within a 3 year period for a variety of high value items totalling over $35k. The frequency and type of the claims triggered some fraud indicators and investigation of some of the claims was initiated. The man admitted during interview that at least five of the claims were fraudulent. This case has been referred to the police. The man has significant personal debt which appears to have provided the motivating factor.

A Cocktail of Drugs and Insurance Fraud

One client lodged a burglary claim of $10,000 under a $10,000 contents policy. The claims officer became suspicious about some of the explanations received and referred the claim for investigation. After investigation by the insurance company Police served a warrant on the insured's home. Along with drug paraphernalia, extensive property was recovered during the warrant, much of which was detailed on the insurance schedule of loss. The insured was subsequently arrested and convicted on multiple fraud and drugs charges.

Subsidised Travel Costs

A man lodged a claim for 4 cell phones and some other items that were stolen from his NZ address while he was travelling overseas. He alleged that all the claimed items were stolen from a wardrobe in his house and no other items were taken or disturbed.

An investigator was appointed because the circumstances of the loss were not very clear.

When interviewed by the investigator it was found that the man had claimed for a lost Samsung phone in 2012 and that phone had been purchased on the same date as one of the phones in his current claim. He further alleged that one of the phones he was claiming, had been purchased from a stranger at a supermarket some days after the 2012 loss.

All above raised suspicions for the investigator including the fact that he believed the 2012 claim could have been false.

After the first interview the insured contacted the claim handler advising that he had found the missing items and he wished to withdraw his claim. He then sent the investigator another e-mail where he changed his story to say that the items had been stolen in India while he was travelling there.

He then admitted that his 2012 claim was false and the phone he currently had in his possession is the same phone he had claimed as lost in 2012. He further admitted that his whole current claim was false and that the bag and all items were stolen in India. In explanation he stated that he knew his policy would not cover the situation occurring outside NZ so he fabricated the loss in NZ.

As a result the investigator recommended that the settled claim value from 2012 should be recovered from the insured and the current claim be declined for fraudulent actions by the insured.

I Want a TV

A woman claimed for a burglary that had occurred at her home in which she had lost $3,000 worth of electronic goods including a 55 inch Sony TV.An investigator was appointed to confirm the full circumstances surrounding the loss.

The woman was asked to prove her ownership of certain items she was claiming. She could not prove the existence of a 55 inch Sony TV but said she had purchased it from Trademe. The police report was obtained by the investigator and there was no TV reported stolen amongst the items listed. The investigator then enquired with Sony regarding the model of TV and found that they had never manufactured a 55 inch model.

The insured was re-interviewed and challenged regarding the genuineness of her claim of having owned the TV. When confronted with evidence she admitted that she had lied about the TV she stated had been stolen in the burglary. She had never owned a Sony 55 inch but wanted one as she wanted HDMI. She then said a 40 inch TV had been stolen but not the one that she had supplied details of earlier.

It was further revealed that the "real" stolen 40 inch TV was in itself a stolen item, having been supplied by a convicted thief introduced by the insured's brother and that is when he supplied the TV.

The claim was declined and referred for prosecution.

Plumber's Invoice

A plumber who had done work on a woman's rental properties identified an invoice on his letterhead that had not originated from him, that had been paid by the insurer.

The invoice related to repairs to sewage drains to a sleep out and an investigation showed there was no sewage connected to the sleep out. The invoice had been blanked out, retyped and photocopied.

The insurers had strong reason to believe some of her loss of rents claims have been false as well. Her full claim has been declined and referred for prosecution.

Emergency Accommodation

An insurer did an audit of an emergency accommodation claim where the insured party had said they had moved out of the house.

Investigations showed that the insured never moved out of the house and in fact, was still living in the house.

Commercial Boarding House

A rental property owner had insured eight properties, which on investigation were shown to be commercial boarding houses.

He had misleadingly insured them as simple domestic properties. EQC had paid out significant amounts for repairs to the properties before discovering they were boarding houses and therefore not entitled to EQC cover. Investigation showed the person was double invoicing to EQC and the insurer for emergency work and for contents.

The same photographs were presented as evidence of damage to contents at each of the properties. Total exposure for this claim was around $2 million.

Accountant's Damaged Carpet

An accountant made a contents claim for carpet damage caused by a paint spill.

The carpet repairer advised the insurer that the damage was not consistent with a paint spill. Investigation showed previous claims on the Insurance Claims Register that had been declined on the grounds of fraud, were not disclosed. The claim was declined.

Earthquake-damaged Paintings

A claim of $40,000 was made for two paintings, which allegedly were damaged during an earthquake.

The insurer had a scientific forensic examination of the damage, which showed that the damage was inconsistent with falling off a wall and more likely to have been a result of deliberate slashing of the paintings. The whole claim was declined.

Stolen Stock Online

Stock from red zone building in the CBD was being sold online.

This stock had supposedly been unable to be salvaged due to the building being too dangerous to enter and the claim was paid out in full by the insurer. The policy holder was NOT involved in this and he had alerted the insurer when he discovered that the stock had been stolen and was being sold on line. The matter was referred to the police for prosecution.

Not so Vacant Properties

In another loss of rent claim due to EQ damage, the insured had altered some tenancy agreements to show the properties as vacant.

The insurance investigator discovered that tenants had been living in the properties during periods that loss of rent was claimed. The claim was declined and referred to the police for prosecution.

Double Claim

A woman claimed for several items damaged in the earthquake with EQC.

EQC declined her claim due to lack of proof of purchase. The insured then lodged a claim for exactly the same items with her insurer claiming that they had all been stolen after the earthquake. An investigator discovered that the woman had never owned the items and the claim had been fabricated.

The claim was declined and referred to the police for prosecution.

Rental Income Loss

A property developer with approximately 30 rental properties was claiming for loss of rental income due to houses being uninhabitable when the properties still had tenants living in them.

The Insured had also completed fictitious tenancy agreements for properties that were not tenanted at the time of the earthquake so that they qualified for loss of rental income. For properties that were deemed to be repairable, the insured had removed property and lodged burglary claims.

The matter was referred to police for prosecution.