Must an insurer provide evidence when insurance fraud is suspected?

Yes, if an insurer suspects insurance fraud, they must be able to prove it with evidence. Therefore, when they suspect insurance fraud, they always launch an investigation. In fact, proving insurance fraud is not an easy task. Therefore, they have various investigative methods to uncover the truth.

An insurer must carefully examine whether there is indeed intent. In fact, it may also be the case of a mistake or misunderstanding. For example, it frequently happens that an insured accidentally fills out the claim form incorrectly. Or that someone does not understand the terms used and therefore says something wrong. The insurer must be able to prove with evidence that it is not a misunderstanding or mistake, but intentional deception of the insurer.

How do they collect evidence of insurance fraud?

There are different investigative methods to prove insurance fraud. Each insurer uses different investigative methods. Some of the investigations the insurer conducts itself, but they may also outsource it to an outside investigation firm or expert. An insurer can gather evidence of insurance fraud by:

• Engage a circumstance investigator to interview the insured or third parties involved. An insurer will always first seek redress from the insured itself.
• Collect personal data from various sources. Important sources include the RDW license plate register, the Chamber of Commerce, the Land Registry and, of course, the Internet. In addition, they can also collect information from tip-offs or witnesses.
• Gather information through observation, accident analysis, note check, fire (technical) investigation or a search for burglary traces.
• Use information from the financial institution alert system. This system contains details of individuals who are at risk.
• Deploy predictive software. This tool is widely used by insurers. Predictive software distinguishes between claims that are approved immediately and claims that must be investigated because of suspected fraud.

Investigation costs to be borne by fraudster

Has the insurer found evidence of insurance fraud? Then the investigation costs are borne by the fraudster. Fair enough, since there would be no costs if no fraud had been committed. These costs can sometimes be substantial, especially if an outside investigative agency or expert must be hired.