Insurance Law
Fraud and Insurance
Insurers carry the onus of proving fraud. The normal civil burden of proving the balance of probabilities applies to fraud claims, however, it has been held that the more serious the allegation of fraud, the higher degree of probability that has to be established.
Fraud is considered a very serious allegation requiring clear evidence.
Types of Fraudulent Insurance Claims
Five areas of fraudulent claims were classified in the case of Agatitos –v- Agnew [2002] Lloyd’s Rep.I.R.573. These areas are:
- Where the Insured suffered no loss.
- The insured loss was less than he claimed.
- The insured believed at the time of his claim that he had suffered a loss, but having later discovered that he had suffered no loss at all or a loss smaller than that claimed for, failed to correct the loss.
- The insured suffered a genuine loss but suppressed a defence known to him which might be available to the insurer.
- The insured has a genuine claim but has used fraudulent means or devises to advance it.
For more detailed information see the following article from our In Business Newsletter entitled : Insurance claims and the issue of fraud.
Insurance Fraud Team
Our Insurance Team which operates out of our office in Lloyd's of London and Canterbury is run by Gary Marshall. Gary's experience is wide. He works with various types of forensics experts and investigators.
Experience shows that the sooner the fraud is exposed and investigated the better the chance of finding the evidence to defeat the fraudster and recovering Insurer's outlay/loss.
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