Insurance fraud is not a victimless or insignificant crime
Insurance protects against significant but uncertain losses through the pooling of risk. Insurance fraud — whether organised or opportunistic — undermines this pooling system because it depletes the funds paid by honest customers, leading to higher premiums.
“Detected and undetected fraud is estimated to cost honest customers and European insurers €13bn a year”
Behind the scenes of real-life
insurance fraud investigations
Every year, Insurance Europe hosts the Insurance Crime Platform, a space where professionals and experts exchange intelligence and share best practices on fraud.
This year's edition featured the testimonies of fraud investigation specialists on real-life insurance fraud cases and the modern techniques used to uncover them.
Below, we will share these cases, each one a real-life example of how fraud operates, how it gets detected, and why cross-border cooperation matters.
Hiding in plain sight
Travel insurance fraud | Cross-border
What began as a straightforward travel insurance claim for a road traffic accident abroad — with limited reported injuries — evolved over several years into something far more significant. By the time the claim reached close to €2 million, it was based on allegations of severe and permanent disability. The medical trajectory simply did not match the original injury, and that inconsistency prompted investigators to look further.
Using open-source intelligence (OSINT), investigators reviewed publicly available online content. What they found told a very different story: social media posts showed the claimant moving independently, attending events, and participating in everyday activities entirely at odds with the level of disability being claimed. When investigators moved to gather further evidence, the social media accounts of both the claimant and their family were deleted simultaneously — a sudden and coordinated disappearance that itself served as a signal. With the support of specialised legal counsel in France and through international cooperation, the case was successfully challenged on appeal.
Key takeaways:
OSINT can be a powerful investigative tool, surfacing important insights from information that is already publicly available. Sudden, coordinated changes in online behaviour can be a strong indicator that something is wrong. And in cross-border cases, having the right legal expertise in the right jurisdiction is not a detail, it is often what determines the outcome.
Why this matters:
Fraud does not always declare itself immediately. It can develop gradually, growing in scale and complexity over time. Left undetected, cases like this can result in significant financial losses that ripple through the system, generating costs that are ultimately passed on to honest policyholders.
Insurance fraud myths versus reality
A little bit of fraud doesn't hurt anyone
False
Insurance fraud is often linked to serious organised crime and can fund the wider activities of criminal gangs. Many orchestrated frauds such as “crashes for cash” have implications for innocent road-users and put other people’s lives at risk.
Insurance fraud is growing
It’s more complicated than that
Insurers are using increasingly sophisticated techniques in order to successfully detect more and more fraud. At the same time, fraudsters are making use of technology, third parties and other “blind spots” to perpetrate criminal acts. Detected fraud is growing, but so too are potential blind spots. What is certain is that the problem of fraud persists.
Only fraudsters pay for insurance fraud
Incorrect
Insurers collect and administer their customers’ premiums to spread risk across the population. The bill for insurance fraud, ie, the fraudulent claims payouts and the cost of insurers’ prevention efforts, is picked up by honest customers.
Insurers are "fair game"
False
Insurance fraud is a serious crime that can result in major consequences for fraudsters, who may find their future job prospects affected, find it harder to obtain insurance and even face the prospect of imprisonment.
Nobody will find out if someone commits fraud
Untrue
Insurers are committed to doing everything they can to detect, disrupt and prosecute anyone attempting to fabricate a claim. Insurers are becoming increasingly effective at sharing intelligence and information about committed frauds to prevent them from reoccurring. This includes naming and shaming fraudsters.
Insurance fraud is easy to commit
Not true
While many frauds are committed by opportunists, the more elaborate frauds require planning, knowledge and expertise. Insurers continue to strengthen their systems and checks, as well as to collaborate with other stakeholders to fight all types of frauds.
The police don't care about insurance fraud
Wrong
Insurers cooperate with law enforcement agencies in many countries, as people who commit insurance fraud often commit other offences, such as tax fraud or defrauding social services. Fighting fraud is in the common interest of everyone except those that commit it.
Fraud stays the same
It’s more complicated than that
Cyber-enabled insurance fraud and identity fraud are two growing areas and insurers are aware of the changing nature of fraud. Insurers are increasingly making use of advanced analytical software to identify cross-industry patterns and alert the industry to fraudulent networks, for instance.