False insurance claims

Insurance fraud are all acts which claim policyholder or third party of an insurance company with intent to defraud insurance benefits. This corresponds to the general offense of fraud under § 263 StGB. The offense of insurance fraud under § 265 of the Criminal Code includes the act constituting the offense, that an insured item is damaged or destroyed. Insurance fraud as a separate offense ( § 265 StGB version) no longer exists.

Constituent elements of

Insurance fraud requires a willful, the offender and leads to lack of conformity of his behavior.

• In the intentional or culpable induction of an insured loss a policyholder causes planned a loss event. It is claimed against the insurance company that the damage occurred by a random event. According to § 81 para 1 VVG the insurance company is exempt from an obligation in such a case. The elements of § 263 para 3 No 5 of the Penal Code is met ( Autobumser ).
• In a fictitious damage no damage has occurred in reality, it is only pretended. Again, there is no obligation of the insurance since they must make only one real damage and an insured event has not occurred. Again, the elements of § 263 para 3 No 5 of the Penal Code is met, where appropriate, may also feigning an offense under § 145d paragraph 1 PC available.
• In the case of redefining a harmful event has occurred, but for which no insurance cover is provided so that a policyholder reports incorrect event circumstances and simulates the occurrence of an insured event. This also falls under the criteria of § 263 para 3 No 5 of the Criminal Code.
• In an exaggeration, although there is an insured loss, but here is the illusion that the damage is higher than was actually incurred.

The criminal act is a criminal offense and is punishable by imprisonment from 6 months to 10 years ( § 263 paragraph 3 sentence 2 No. 5 of the Criminal Code).

Extent of insurance fraud in Germany

In anonymous interviews were at about a quarter of respondents said they have against their insurer made ​​at least in one case, false information. Redefinitions have a share of 51% of all fraud, exaggerations come as the next group of cases to 43%. The fraud of the Fingierung (5% ) and the intentional induction (1%) in Germany play virtually no role. In casualty (property, liability and motor insurance) estimates come in almost all industrialized countries to the conclusion that around 10% of all damage claims are fraudulent. In some lines even a share of 50 % is assumed. In the Anglo -Saxon area of ​​insurance fraud due to the huge damage is referred to as "quiet catastrophe ".

Loss for the insurance company by insurance fraud

Excessive repayments lose the insurer annually money they have legitimate claims for not more readily available. According to the General Association of German Insurers (GDV ) of the annual loss is due to insurance fraud in the property and casualty insurance at around four billion euros. Around two billion on motor insurance, a billion on property insurance and about a half a billion on the general liability insurance. Although insurers have merged to form an insurance pool in which they reinsure each other, but is the result of excessive insurance fraud, that prices will rise relatively strong.

Measures the insurer against insurance fraud

As countermeasures include independent insurance adjuster to call, the review without knowledge of each other the same damage. Come on approximately the same results, notification of the claim appears to be justified. An important tool is the no-claims discount, which will be granted if the insurer need not provide damage services to the insured. In eintretendem insured event, the no-claims discount will automatically be downgraded or abolished.

The use of fraud detection software can only be one - and a rather under - than overestimated in complex insurance law - its block. To this end, many insurance companies put a an automated test procedure, the so-called " Intelligent analysis of injury " (ISP). ISP checks claim files based on decision logics based on fuzzy logic. Another measure is the common warning and information database of the General Association of German Insurers ( GDV) organized insurance companies Uniwagnis.

Staff employed or contracted by insurance external insurance detectives are determined by own research, the present case of an insurance case circumstances and get your own image of a loss situation to educate in this way the insurance company about the real circumstances of the case.