Does an insurer have to provide evidence in case of suspicion of insurance fraud?

Yes, if an insurer suspects insurance fraud, they must be able to prove it. That is why they always launch an investigation in case of suspicion of insurance fraud. Proving insurance fraud is not an easy task. Therefore, they have different investigation methods to bring the truth to the table.

An insurer must carefully examine whether there is indeed intent. It may also be the case that a mistake or misunderstanding has occurred. It often happens that an insured person accidentally fills in the claim form incorrectly. Or someone does not understand the terms used and therefore says something wrong. The insurer must be able to prove that it is not a question of a misunderstanding or mistake, but of deliberately misleading the insurer.

How do they collect evidence of insurance fraud?

There are different investigation methods for proving insurance fraud. Each insurer uses different investigation methods. A number of investigations are carried out by the insurer itself, but they can also be contracted out to an external investigation agency or an expert. An insurer can collect evidence of insurance fraud by:

• Call in a circumstantial investigator to interview the insured or involved third parties. An insurer will always first seek redress with the insured himself.
• Collect personal data from various sources. Important sources include the RDW vehicle 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.
• Gathering information by means of observation, accident analysis, note check, fire (technical) investigation or a burglary investigation.
• Use information from the Financial Institutions Alert System. This system contains the details of individuals who pose a risk.
• Using predictive software. This tool is widely used by insurers. Predictive software distinguishes between claims that are immediately approved and claims that must be investigated due to suspicion of fraud.

Investigation costs to be borne by fraudster

Has the insurer found evidence of insurance fraud? Then the investigation costs are for the account of the fraudster. This is fair, as there would be no costs if no fraud had been committed. These costs can sometimes mount up considerably, especially if an external investigation bureau or expert has to be hired in.