With Fraud
you don't play
Preventing fraud is a central task at Compañía de Seguros Insur S.A. and PAS, Brokers, employees, policyholders 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, policyholders, policyholders and other participants in the insurance market.
Insurance fraud is any action or omission tending to illegitimately obtain a benefit by policyholders, insured parties, third parties, insurance agents, as well as other professionals involved in the contracting, issuance and/or accounting of insurance, or in the production, communication, intervention and/or repair and collection of a claim.
Fraud is a deceptive act or omission by which the fraudster seeks to gain an advantage for himself or a third party. Most jurisdictions have regulations against insurance fraud and in most it is a crime.
Insurance fraud has direct consequences for the entire Company and not only harms the insurer itself, since it affects the system as a whole and therefore it is important to raise awareness among all system participants.
Suggestions to PAS, Brokers and Instituting Agents in the adoption of anti-fraud measures, for three key moments
of their interaction with the client:
- Prove the identity of the Policyholder / Insured / Beneficiary / Payer of the policy to be signed and in a reliable manner.
- Obtain complete personal data: telephone numbers, reference email, work activity and/or profession and document them.
- Determine if you were previously insured and the status of the policie
- Request the necessary information to comply with Law 25,246 on the Prevention of Money Laundering and Financing of Terrorism.
- Request the information that the insurer requires for a good insurance subscription.
- Pay special attention to increases in the sum insured, in relation to the income of the insured.
- Request the reasons that originate the endorsement, taking into account that it may entail an attempt to report an upcoming claim.
- Reasons for choosing the insurer.
- Insurance and claims history.
- Business history, credit, and tax situation.
- Motivation for contracting the coverage – insurable interest.
- Reluctance to provide the requested information.
- Request for retroactive coverage.
- Request for unreasonable coverage and/or sums insured based on the insured interest to be covered.
- How much time passed from the occurrence of the accident to the communication?
- Do you request additional documentation, if applicable, before Insur requires it?
- If there is any circumstance that draws your attention to the Claim/Attitude of the client, do you comment on it to the Insurer?
- Does it analyze whether the description is confusing and/or contradictory of the circumstances of the incident?
- Does it verify if there is reluctance to provide the requested information?
They should always consult with their insurer in case of any doubt or eventuality and communicate any new developments that may arise.
A good anti-fraud policy, known and endorsed by all market players, helps society as a whole and creates a good insurance culture.
Beyond the specific cases where a fraudulent attempt is perceived to make a profit by a particular person or a gang formed for criminal purposes, there is an aspect that clearly exposes that fraudulent actions that are not detected, are paid, for example, in claims, and have a direct impact on the costs of insurers. An insurance company, like any other activity, must be profitable and efficient; that is to say, it cannot support losses without taking corrective measures and one of them is the rate it charges for the service it provides, that is, the insurance premium will be more expensive.
An effective and proactive management of the fraud prevention policy ends up becoming a powerful tool to improve the competitiveness of the insurer and an act of responsibility for the benefit of all parties, thus creating a firm and responsible insurance culture. .
The professional and efficient action of advisory producers and brokers in collaboration for this fight helps all market participants and obtains a relative improvement in prices.
Dissuasion and prevention actions must be disseminated to all policyholders and insured persons, who must be alerted, for example, in order that:
- They should never sign blank claim or loss report forms.
They must never accept money, or sign documents or agree to powers of attorney whose scope and effects they do not understand, nor must they admit facts that have not happened, nor accept legal assistance provided by unknown third parties.
They must not modify the state of the things damaged by the accident (with the exception of the salvage obligation in order to avoid or reduce the aggravation of the damage to the best of their ability), nor fraudulently exaggerate the damage; employ false evidence; or provide false supplemental information.
Fraud directed against the insurer causes damage to the entire community, affects premium costs, and occurs when people cheat the company (and/or the insurance advisory producer) to collect money or obtain some other advantage to which you are not entitled.
Fraud involving the insurer is a crime. The variation, simulation or misrepresentation of personal, temporary, objective circumstances, of causality, of place, and the deliberate provocation, or the total or partial simulation of the occurrence of the claim, are some of the most common forms of fraud, which leads to admit it as natural, without understanding the seriousness that it entails.
False statements or any reticence of circumstances known by the insured, even made in good faith, which if taken into account would have prevented the contract or modified its conditions, make the contract null and void, resulting in more serious consequences in the face of fraudulent or in bad faith
Remember that you can be voluntarily or involuntarily involved in a fraud scheme. There is always the risk that someone with very bad intentions will induce them to carry out practices that are outside the law.
They must never agree to cooperate in carrying out a fraud scheme.
They must never provide the data or access to their policies to third parties when this is not justified, nor allow the real personal, temporary, objective or causal circumstances related to the occurrence of a claim to be replaced or simulated.
They must try to obtain real data and document, according to their possibilities, the circumstances of the incident.
They should always consult with their insurer in case of any doubt or eventuality and communicate any new developments that may arise.
Remember that you must report the occurrence of the accident. Try to formalize said complaint and be informed of the claim number for which it will process internally in the entity.
Keep in mind that your coverage may have limitations, in terms of items, risks or concepts not covered.
They must be aware of the offer of coverage, generally at a cost below the market average, by unauthorized dealers.
Although it is allowed to insure the same interest and risk with more than one insurer, all entities must be notified in advance. It is not lawful for the compensation to exceed the amount of damage suffered, nor to pursue collection with respect to a claim that has already been compensated by another insurer.
