is not a game
Preventing fraud is a central task at Compañía de Seguros Insur S.A. and the PAS, Brokers, employees, reinsurers and policyholders are a fundamental part of that equation.
Insurance Company Insur S.A. has implemented a series of policies and procedures to prevent fraud. Good practices, fair treatment and good faith must be rooted in all our actions as insurers, reinsurers, policyholders and other participants in the insurance market.
Fraud in insurance is any action or omission tending to illegitimately obtain a benefit on the part of the policyholders, insured, third parties, insurance agents, as well as other professionals involved in the hiring, issuance and / or accounting of insurance, or in the production, communication, intervention and / or repair and collection of an accident.
Fraud is a deceptive act or omission by which the scammer seeks to gain advantage for himself or for a third party. Most jurisdictions have a rule against insurance fraud and in most it is considered a crime.
Insurance fraud has direct consequences on the entire Society and not only harms the insurer itself, as it affects the whole system and therefore it is important to raise awareness to all participants of the system.
Suggestions to PAS, Brokers and Institory Agents in the adoption of anti-fraud measures, for three key moments of their interaction with the client:
At the time of the proposal, endorsement or modification of the insurance contract:
- Prove the identity of the Policyholder / Insured / Beneficiary / Payer of the policy to subscribe in a reliable manner.
- Obtain complete personal data: telephones, reference mail, work activity and / or profession and document them.
- Determine if they were previously insured and the status of such policies.
- Request the information necessary to comply with Law 25.246 on Prevention of Money Laundering and Financing of Terrorism.
- Request the information that the insurer requires for a proper insurance subscription.
- Pay special attention to increases in the sum insured, in relation to the insured's income.
- Request the reasons that give rise to the endorsement, taking into account that it may result in an attempt to report a claim next.
- Reasons for the insurer's choice.
- History of insurance and claims.
- Commercial history, credit, and fiscal situation.
- Motivation for contracting coverage - insurable interest.
- Reluctance to provide the requested information.
- Retroactive coverage request.
- Application for coverage and / or unreasonable amounts insured based on the insured interest to be covered.
When reporting a claim, pay attention to the following basic requirements:
- How much time passed from the occurrence of the incident to the communication?
- Does the client request additional documentation if applicable before Insur requires it?
- If there is any circumstance that catches the attention of the Client's Claim or attitude, it should be brought to the Insurer attention.
- A confusing and / or contradictory description of the circumstances of the incident should be analyzed.
- Reluctance to provide the requested information by the client should be checked.
You should always check with your insurer in case of any doubt or eventuality and communicate developments that arise.
A good anti-fraud policy, known and promoted by all market players, helps the whole society, and creates a good insurance culture.
Beyond the specific cases where a fraudulent attempt to obtain benefit is perceived by a particular person or a group of people conformed with criminal purposes, there is an aspect that clearly exposes that the fraudulent actions that are not detected have consequences, for example in claims, as they have a direct impact on the costs of insurers. An insurance company, like any other activity, must be profitable and efficient; that is, it can not support losses without taking corrective measures. One of them is the fee charged for the service it provides, making the insurance premium to be be more expensive.
An effective and proactive management in the policy of fraud prevention ends up becoming a powerful tool to improve the competitiveness of the insurer and an act of responsibility for the benefit of all parties, creating, in this way, a strong and responsible insurance culture.
The professional and efficient actions of the advisory producers and brokers in the collaboration for this purpose, helps all market participants obtain a relative improvement in prices.
The actions of deterrence and prevention should be disseminated to all policyholders and insured persons, who should be alerted, for example, of the following:
- They should never sign blank claim forms or claim reports.
- They must never accept money, or sign documents or agree to powers of attorney whose scope and effects they do not understand, nor recognize facts that have not happened, nor accept the legal assistance provided by unknown third parties.
- They must not modify the state of the things damaged by the loss (except for the obligation to save in order to avoid or lessen the aggravation of the damage to the extent possible), as well as fraudulently exaggerating the damage; use false evidence; or provide false complementary information.
- The fraud that is directed against the insurer causes damage to the entire community, affects the costs of the premiums, and occurs when people tries to deceive the company (and / or the insurance advisory producer) to collect money or obtain some another advantage to which he has no right.
- Fraud that affects the insurer is a crime. The variation, simulation or misrepresentation of personal, temporary, objective, causality, place, and deliberate provocation, or the total or partial simulation of the incident, are some of the most common forms of fraud, in time even accepting it as natural without understanding the seriousness that it entails.
- False statements or any reluctance of circumstances known to the insured, even when made in good faith, which if taken into account would have prevented the contract or modified its conditions, voids the contract, resulting in far greater consequences than those of malicious attitudes or bad faith.
- Remember that you can be voluntarily or involuntarily involved in a fraud maneuver. There is always the risk that someone with very bad intentions will induce you to perform practices that are outlawed.
- They should never agree to cooperate in carrying out a fraud scheme.
- They should never provide data or access to their policies to third parties when this is not justified, nor allow them to substitute or simulate the real personal, temporary, objective or causal circumstances related to the occurrence of a loss.
- They should try to obtain real data and document, according to the possibilities, the circumstances of the accident.
- They should always consult with your insurer in case of any doubt or event and communicate any news that may arise.
- Remember that you must make a report of the incident. Try to formalize the claim and be informed of the claim number for which you will process it internally in the entity.
- Keep in mind that your coverages may have limitations, in items, risks or concepts not covered.
- They must be warned regarding the offer of coverage by unauthorized marketers, generally at cost below the market average.
- Although it is permitted to ensure the same interest and the same risk with more than one insurer, it must be notified to all entities beforehand. It is not lawful for the compensation to exceed the amount of damage suffered, nor to pursue the collection in respect of an accident that was already compensated by another insurer.
Let's all fight against fraud, Insur SA Insurance Company does, and has a specific department of analysis and prevention. Fraud in the insurance harms us all, letís know its implications, spread awareness and fight together to prevent and eradicate it.
If you have any questions or concerns, please contact Dr. Juan Martin Devoto on the telephone (+ 54 11) 5236-6089 or to the mail:†firstname.lastname@example.org
We are part of the Atradius Group, the largest international and integrated credit insurers in the world.