Accidental Fraud

It is very possible for individuals to unwittingly commit insurance fraud, or at least to be accused of it. Insurance companies cannot reject claims unless they can prove that there has been intent on the part of the claimant to perpetrate a fraud. This is difficult, but with such an enormous sum of fraudulent claims being made every year the insurance companies have to do all that they can to protect themselves, and their customers from the impact of fraud.

 

One particular problem is that, according to the Financial Ombudsman, a body that offers a type of high court in regards to insurance claims, documents that have been forged do not necessarily mean that a claim is fraudulent. Whilst this might seem rather peculiar, there are, in fact, good reasons for it.

 

Firstly the customer may not necessarily know that the document they have obtained and are using to support their claim is fraudulent. More relevantly though, insurance firms often insist that customers produce receipts for the items that they claim for, thus putting customers in a position where they may be tempted to create substitutes for lost receipts. Thus the Ombudsman has to determine what led a customer to create a false receipt, whether it was solely to substantiate transactions that actually took place, or whether intent was there for the individual to claim more than they were due.

 

In some recent cases involving claims for written-off vehicles, firms appear to have asked customers to substantiate the original purchase price of their vehicle. As a result, some customers who had lost the original sales material (or perhaps purchased the car through other routes) have sent in false documents.

 

Other customers have produced false documents to try and substantiate a higher price than they actually paid. This is clearly wrong, but it does not justify the firm voiding the policy. The customer's claim is for the present market price, not the original purchase price. As long as there is no doubt about ownership and no suggestion of fraud, the firm is not allowed to meet such claims on the basis of the normal market value.

 

It is, therefore, quite possible to accidentally commit insurance fraud, and it is also very possible to do it trying to validate a claim that you fear may otherwise be rejected. Ultimately, though, the Ombudsman is set up to support the claimants, as it should do, and if you fear that a claim might be rejected the Ombudsman will support you even if the information that you have provided is not as comprehensive as perhaps it should be.

 

The easiest way of ensuring that your claims are paid is to fill in your application form as comprehensively as possible when you make the initial application. This way the insurance company is most likely to accept that you have done everything you can to make them aware of all the details, and you can never submit too much information. If you do your research properly you will get a good value policy, whatever cover you require.

 

The Co-operative Bank offer a range of home insurance products.

 

For details of proper industry practice, visit the Association of British Insurers.

 
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