Insurance fraud

from Wikipedia, the free encyclopedia

Insurance fraud are all acts by which policy holders or third parties by an insurance company in fraudulently claim insurance benefits. This corresponds to the general offense of fraud according to § 263 StGB . The offense of insurance fraud under Section 265 of the Criminal Code includes the act of damaging or destroying an insured item. Insurance fraud as an independent offense (Section 265 StGB old version) no longer exists.

Constituent elements

Insurance fraud requires deliberate action on the part of the offender and leads to a breach of contract.

  • In the event of willful or culpable causing of an insured loss , a policyholder causes a planned loss event. It is asserted to the insurance company that the damage occurred as a result of a random event . According to Section 81 (1) VVG, the insurance is exempt from a performance obligation in such a case. The offense of § 263 Abs. 3 Nr. 5 StGB is fulfilled ( autobumser ).
  • In the case of fictitious damage , no damage has actually occurred, it is only faked. Here, too, the insurance company is not obliged to provide benefits, as it only has to pay for real damage and an insured event has not occurred. Here, too, the offense of Section 263, Paragraph 3, No. 5 of the Criminal Code is fulfilled; if necessary, the pretense of a criminal offense according to Section 145d, Paragraph 1 of the Criminal Code may also exist.
  • In the case of the redefinition , a damaging event has occurred, for which, however, there is no insurance cover, so that a policyholder reports false event circumstances and simulates the occurrence of an insured event. This also falls under the criteria of Section 263 (3) No. 5 StGB.
  • In the case of exaggeration, there is indeed an insured loss, but here it is pretended that the loss is greater than the actually incurred.

The act is a criminal offense and is punishable by imprisonment for up to five years or a fine. In particularly serious cases, namely when the perpetrator fakes the insured event after he or someone else has set fire to something of significant value for this purpose or has destroyed it in whole or in part by setting fire, or a ship to sink or stranded, the act is threatened with imprisonment from 6 months to 10 years (Section 263, Paragraph 3, Sentence 2, No. 5 of the Criminal Code).

Extent of insurance fraud in Germany

Professional insurance fraudsters who repeatedly and on a large scale defraud insurance companies are often the focus of public attention. Much of the insurance fraud, however, comes from ordinary insurance customers who only cheat an insurance company for a relatively small amount once or twice in their life. The exact number of fraudsters and the exact damage cannot be precisely determined. In anonymous interviews, over a quarter of those questioned stated that they had given their insurer false information in at least one case. The most common redefinitions and exaggerations occur. The fraudulent forms of fraud and deliberate induction are the standard forms of fraud used by professional insurance fraudsters, but they are rare compared to exaggerations and redefinitions. In the composite area (property, liability and motor vehicle insurance), estimates in almost all industrialized countries come to the conclusion that around 10% of all claims reports are fraudulent. In some sectors even a share of 50% is assumed. In the Anglo-Saxon area, insurance fraud is known as a "quiet catastrophe" due to the enormous damage it causes.

Damage to insurance companies from insurance fraud

Due to excessive repayments, the insurers lose money every year that they no longer have readily available for legitimate claims. According to the General Association of the German Insurance Industry (GDV), the annual damage caused by insurance fraud in property and casualty insurance is around four billion euros. Around two billion of this is accounted for by motor insurance, one billion by property insurance and around half a billion by general liability insurance. While insurers have formed an insurance pool in which they reinsure each other, the consequence of excessive insurance fraud is that insurance policy prices rise.

Measures by insurers against insurance fraud

Previous measures by insurers have focused primarily on controlling potentially fraudulent claims; So far, prevention has not been practiced, although it would be possible. Independent damage assessors should be mentioned as countermeasures in the area of ​​controls. Occasionally, for example in the case of claims reports in the area of ​​occupational disability, external insurance detectives commissioned by insurers are also used.

Automatic fraud detection software provides the first indications of a suspicious claim. Many insurers use an automated test procedure, the so-called "Intelligent Damage Test" (ISP). ISP checks damage files using decision logic based on fuzzy logic .

Another measure is the information system of the insurance industry (HIS), formerly called Uniwagnis. HIS is a warning and information database of the insurance companies organized in the German Insurance Association (GDV), in which suspicious policyholders are entered.

literature

  • Dirk-Carsten Günther: Fraud in property insurance. Karlsruhe 2006, Verlag Versicherungswirtschaft ISBN 3899522796
    • ders: Fraud investigation versus data protection , VersR 2003, 18
    • ders .: Proof of self-arson foundation , r + s 2006, 221
  • Werner Lücke: Insurance fraud in property insurance , VersR 1996, 785
  • Andreas Knaus: Insurance fraud from the perspective of contract theory and aspects of costly state verification models. 2002, dissertation.de ISBN 3898254127
  • Jörg Schiller: Insurance fraud as an economic problem. Karlsruhe 2004, Verlag Versicherungswirtschaft ISBN 3899521668

Individual evidence

  1. ↑ Jörg Schiller, Insurance Fraud as an Economic Problem , 2004, p. 36 f.
  2. ↑ Ulbricht / Fähnrich VW 2005, 1490.
  3. ↑ General Association of the German Insurance Industry ( Memento of the original from April 20, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.gdv.de

Web links