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The rising cost of fraudulent claims

Faking a bad case of whiplash might be something many think was popular during the 1980s or ’90s, but in fact it’s still running rife through the regional general insurance industry.

Those trying to pull a swift one over their insurers know which buttons to push, with almost half of the fraudulent activity that goes on in Australia and NZ being attributed to bogus insurance claims.

KPMG’s biennial fraud survey shows many people are still happy to take a punt with a faked injury or sham stolen vehicle claim.

The survey, now in its 17th year, tracks fraud and misconduct affecting about 200 private and public sector companies in Australia and NZ.

Almost half of the fraud losses – which increased from $1.5 million per organisation in 2008 to $3 million this year – land squarely at insurers’ feet.

Since 2008, bogus claims from external sources have cost the industry more than $142 million.

The report estimates the general insurance industry has received 30,882 false claims since 2008, costing it $93.3 million. False motor accident claims alone amount to $45.1 million.

Personal insurance also rated a mention in the survey, with six false claims or $32,735 in losses.

All other type of bogus claims cost the industry in excess of $1 million.

Despite the increases, only 20% of respondents believe fraud is a serious problem in their organisations.

KPMG Forensic Partner Garry Gill says the survey should act as a wake-up call for insurers, especially as the industry is the key victim of fraud.

“Talking to people in the industry, especially on the side of motor vehicle claims, it’s a very significant chunk of the fraud,” he told insuranceNEWS.com.au.

Mr Gill attributes the increase in part to the global financial crisis, with more people feeling financial pressure.

The survey says whistleblowers are essential for the detection of fraudulent activities. About says 20% of cases are picked up as a result of action by whistleblowers, while 38% of “red flags” are overlooked in major fraud cases.

He says the best action for insurance companies to take would be to invest in hotlines for anonymous tips. (The Insurance Council has operated a “Fraud Hotline” for about 18 years, and a private investigations company also launched its own whistleblower service recently.)

“An even better way to detect fraudulent claims is to put data analysis in practice in place. A lot of insurers already do have various controls in place to pick these things up.”