Types of Insurance Fraud (Bodily Injury Claim)

Staged Accident

In Bodily Injury Claim, a staged accident can be defined as a collusion between two parties mainly the
claimant and the defendant to stage an accident between both vehicles even though one of either
and their vehicle was not even present at the scene. In most cases, the plaintiff was indeed injured
due to a hit-and-run scenario where the plaintiff was unable to identify the registration number of the
vehicle at fault or even solely due to his own negligence; of which would invalidate any claims made.
To facilitate the plaintiffs claim, they create a phantom driver (usually the colluded defendant)
whom would then lodge a police report admitting that he or she has collided into the plaintiff and
caused severe injuries and damages to both the plaintiff and the vehicle.

Non-Involvement

A non-involvement scenario mimics that of a staged accident with the term of co-operation being the
only difference. In a staged accident, both parties have made an agreement to collude; however, in a
non-involvement case only one of either party happens to be the main culprit, whilst the other
innocent. Common cases involve the claimant falsely accusing the defendant (insured) to be involved
in a certain accident, when in fact the accused was absent from the scene of the accident. It is also
important to note that such false allegations can also be made the other way around, with our insured
accusing the third party.

Switching of vehicles

Self-explanatory, fraudulent actions as such tend to be common among accidents occurring in the
rural areas. These could point to the main fact that most vehicles in the rural areas are not insured.
When met with an accident, the claimant would then have the uninsured vehicle swapped with
another vehicle which is insured in an attempt to legitimate their claim against a defendant. Other
reasons for switching out involved vehicles suggests them to be unregistered or even stolen.

Switching of rider and pillion / driver and passenger

Amongst one of the most common fraud scenarios, claimants would usually have alleged themselves
to be either a pillion or a passenger in a claim against the insurance company. This involves falsely
claiming that they were the passenger in the occurrence of an accident while they were actually the
rider or driver of the vehicle. The main reason that stands out is the fact that pillions and passengers
injured in an accident are not liable nor negligent in respect to an accident. This could mean that the
Court would allow 100% quantum paid to them irrespective of what the liability was judged upon the
driver themselves. As it is highly improbable for ordinary citizens to have knowledge about the legal
mechanism in claims initiation; it wouldnt come as a surprise to find a legal agent or even the third-
party solicitor responsible for puppeteering such fraudulent actions.

Non-accident

A non-accident case arises when the claimant alleged that an accident has occurred and has injured
them in some way while in truth, no road accident has ever happened or whatever injury they were
trying to claim from the insurance company was instead a result of an earlier event or mishap not
relating to the said accident. An exemplary situation could be depicted as such:
A claimant working at a construction site met with a work-related accident of which has resulted in
his arm to be fractured. Being illegally employed without a working permit would mean that he wasnt
entitled to any medical insurance. The claimant then colludes with a defendant whom then lodges
a false police report purporting an occurrence of an accident together with the claimant resulting in
the named injury. It is also noted that whatever furbished medical report to the examiner is highly
plausible to be fabricated. Admittedly, non-accident fraud matters are considered considerably
difficult to expose.

Accident before policy cover

Any accident occurring outside the timeframe of the agreed policy coverage period would void any
claims made against the insured. This would compel the claimant or defendant to renew their policy
spontaneously when involved in an accident by either contacting their insurance agent or even doing
it themselves online. They would then lodge their police reports and delay the time of accident to right
after they had renewed their policy. Deemed to be an almost desperate act, such cases are rather easy
to spot first hand by cross-referencing time of policy cover and also time of accident. However, it is
also noted that such cases could arise out of sheer coincidence.

Claim inflation

Claim inflation can be described as an act of exaggerating minor claims from a claimant against the
insurance company. For instance, an abrasion/laceration wound inflicted unto the claimant could be
blown out of proportion as a fractured arm or leg in their subsequent claim. On a higher scale, claim
inflation could encompass false allegations for loss of earnings, even when they could still obviously
continue working within their job scopes despite disabilities; or even for loss of mental capacity, when
all that was inflicted unto the claimant was a minor head injury with complementing GCS upon
admittance to the hospital. It is agreed that such claims should be subjected to thorough investigation
as claimants could possibly collude with medical officers or are able to elude their examinations.

Pre-existing condition

Similar to a non-accident scenario, this situation ensues when the claimant is claiming against the
insurance company for an injury that wasnt directly consequent from the accident itself. An example
to elaborate: A claimant suffering from diabetes was involved in an accident with our insured. She had
suffered abrasions and lacerations on her legs. However due to her pre-existing condition of a diabetes
patient, her leg had to be amputated. She then initiated a claim against us in regard to the amputation
with clear knowledge that the accident had nothing to with her loss. It is crucial to not miss out any
historical medical conditions the claimant could have and also whatever medications he or she may
be currently consuming in order to pick up similar fraudulent claims.