How to Deal With Insurance Fraud

As the number of insurance fraud cases continues to increase, it is crucial to understand how these illegal activities work and how insurance companies and policyholders can avoid them. Fraudsters steal around $308 billion annually from American consumers, making the insurance industry one of the most vulnerable to sharp practices.

In this article, we’ll discuss everything you need to know about insurance fraud so that you can protect yourself from financial loss and 

What is insurance fraud?

Insurance fraud refers to the deliberate intent of an individual or insurance company to misuse information for financial gain. Insurance fraud can be committed by policyholders, insurance agents, or even insurance companies themselves. The most common type of insurance fraud involves policyholders who file fraudulent claims to receive benefits they are not entitled to receive.

Insurance fraud can be a costly crime that affects everyone. Fraudulent claims can cause insurance companies to increase their premiums, leading to higher costs for honest policyholders. Insurance fraud can also lead to financial losses for insurance companies and negatively affect their profitability.

What are the different types of insurance fraud?

Insurance fraud comes in many different forms, and understanding what they are will help you to identify them.

1. Hard Fraud

Hard fraud is the most severe type of insurance fraud that involves deliberate acts of destruction, injury, or theft. Hard fraud is typically committed to obtaining large sums of money from an insurance company. Examples of hard fraud include faking death or injury, staging car accidents, and setting fire to a property to collect insurance benefits.

2. Soft Fraud

Soft fraud is a type of insurance fraud that is less severe than hard fraud. Soft fraud is committed when policyholders exaggerate their claims to receive more benefits than they are entitled to receive. Examples of soft fraud include exaggerating the extent of injuries or damages caused by an accident or claiming pre-existing damages as new damages.

3. Premium Diversion

Premium diversion is a type of insurance fraud that is committed by insurance agents or brokers. Premium diversion occurs when insurance agents collect premiums from policyholders but do not forward them to the insurance company. The agents may use the premiums for their personal gain, leaving the policyholders without insurance coverage.

4. Paper Fraud

Paper fraud is a type of insurance fraud that involves falsifying documents or misrepresenting information on insurance applications. Paper fraud can also include creating fake policies or altering existing ones. Paper fraud is typically committed by insurance agents or brokers who want to obtain commissions or other financial benefits.

5. Staged Accidents

Staged accidents are a type of hard fraud that involves deliberately causing an accident to file fraudulent insurance claims. Staged accidents can be dangerous and can result in severe injuries or even death. Staged accidents can be challenging to detect, but insurance companies are increasingly using technology to identify them.

How can you avoid insurance fraud?

Insurance fraud presents some red flags that may not be immediately noticeable for first-time policyholders. Here’s how you can spot insurance scams:

  • Unusual Claims – Be wary of claims that seem unusual or excessive. For example, a claim for damages that are much higher than the actual cost of repairs may indicate fraud.
  • Pressure to File a Claim – If an insurance agent or contractor pressures you to file a claim, this could be a sign of fraud. They may be trying to profit from the claim or receive a kickback from the repair company.
  • Unsolicited Offers – Be cautious of unsolicited offers for insurance policies or services. Scammers may use high-pressure tactics to convince you to buy a policy or service that is not legitimate.
  • Cash Payments – If an individual or company asks for cash payments instead of checks or credit cards, this could be a sign of fraud. Cash payments are harder to trace and provide no paper trail.
  • False Information – If someone provides false information on an insurance application or claim, this is a clear sign of fraud. It is important to be honest and accurate when providing information to your insurance company.

Tips on protecting yourself from insurance fraud

Now that you understand insurance fraud let’s look at some tips to protect yourself from becoming a victim.

1. Choose reputable insurance companies

When selecting an insurance company, it’s essential to choose one with a good reputation. Research the company online, read reviews, and check their rating with the Better Business Bureau. If you can, ask for feedback from clients with previous experience with the insurance company you’re eyeing.

Make sure to do your due diligence when choosing an insurance company, as your personal details (and money) lie in their hands.

2. Be cautious of unsolicited calls or messages

If you receive a random call or email offering you insurance policies or claiming that you’ve won a prize, block the contact immediately. These types of scams attempt to acquire your personal information, such as your social security number or credit card information, and use it for financial gain.

3. Check your statements

Review your insurance statements regularly to ensure that there are no unauthorized charges. If you notice anything suspicious, report it to your insurance company immediately.

4. Do not sign blank forms

Fraudulent insurance companies will do anything in their power to get policyholders to sign a blank form. Once the person signs the form, the insurer will fill in the document with false information. Always refuse blank forms and ask your insurance company for a thorough explanation of why they need your signature.

5. Keep accurate records

Maintain accurate records of all your insurance policies and claims. This will help you detect any suspicious activity or unauthorized claims.

6. Keep an eye on unsolicited medical providers

Be wary of unsolicited medical providers offering free medical services or procedures. These providers may be attempting to commit insurance fraud.

7. Report suspected fraud

If you suspect insurance fraud, report it to your insurance company and the authorities immediately. Your quick action could prevent others from becoming victims.


Insurance fraud is a significant problem worldwide, but you can protect yourself by understanding how it works and taking the necessary precautions. Be cautious of unsolicited calls or emails, choose reputable insurance companies, keep accurate records, and report suspected fraud immediately. By following these tips, you can protect yourself from becoming a victim of insurance fraud.

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