Fake claims soar as number of travellers rises

Scams vary from overinflating a loss to making claims for fictitious thefts and going as far as filing police reports

Fraudsters are not fussy when trying to rip off insurers, with dodgy claims flying in for anything from missing mobile phones and cameras to lost baggage and wallets and even fake medical complaints.

The scammers have been more active in recent years on the back of increased trips abroad and a greater awareness of how travel insurance works.

General Insurance Association (GIA) chief executive Derek Teo tells The Sunday Times: "With budget airlines, you can travel from as low as $100. Some individuals who are covered by travel insurance think they can recover their travelling costs from their insurance policies by filing fake claims. Some are so bold as to file police reports on the theft of items such as a wallet, even though it didn't happen."

Mr Shane Lowndes, AIG Singapore's head of claims and operations, says: "As the number of people taking up travel insurance rises, so too has the incidence of people making false or inflated insurance claims." The insurer has seen a 130 per cent increase in such claims, from 21 in 2014 to 49 last year.

The scams are many and varied. Some claims are lodged by people who have suffered a genuine loss but exaggerate the value of the loss, while others submit multiple claims for the same loss or make claims for fictitious losses or thefts.


Insurers say most fraudulent travel claims are small-scale, opportunistic incidents such as false declarations for lost baggage or fictitious medical treatment. PHOTO: AGENCE FRANCE-PRESSE

Insurers like AIG and Sompo Insurance Singapore say most fraudulent travel claims are small-scale, opportunistic incidents such as false declarations for lost baggage or fictitious medical treatment.

Sompo chief distribution officer Koh Yen Yen says: "The majority of the cases are soft fraud cases, that is, exaggerated claims. For many of the highly suspicious fraud cases, when we start asking more questions, some insured persons do back off."

She adds that over the past three years, Sompo has seen a rise of about 30 per cent in cases it deems as fraud or soft fraud that required more in-depth investigation.


A property irregularity report should be completed at the airline counter for any claims for baggage delay or luggage damage. ST FILE PHOTO

There are no official statistics on fraudulent travel claims for Singapore. Mr Teo says that GIA's classification of personal accident business includes premium and claims statistics from products like group and individual personal accident and travel insurance, without a breakdown for each product line. 

Along with personal accident and health, travel insurance accounted for 21.6 per cent or $781 million of the total general insurance business last year - up from $711 million in 2014 and $628 million in 2013.

PROBE INTO IRREGULARITIES

If we detect any irregularities which require clarification from the claimant, we will request more information... If there is sufficient evidence that a fraudulent claim has been submitted, the claimant will usually admit to it and offer to withdraw the claim.

MR SHANE LOWNDES, AIG Singapore's head of claims and operations


COVERING TRAVEL COSTS

Some individuals who are covered by travel insurance think they can recover their travelling costs from their insurance policies by filing fake claims.

MR DEREK TEO, General Insurance Association chief executive


SOFT FRAUD

The majority of the cases are soft fraud cases, that is, exaggerated claims. For many of the highly suspicious fraud cases, when we start asking for more questions, some insured persons do back off.

MS KOH YEN YEN, Sompo's chief distribution officer

Claims for the personal accident business, which includes personal accident itself, health and travel, amounted to $77.5 million last year, up from $75.3 million in 2014 and $71.9 million in 2013. Mr Teo estimates that generally about 20 per cent of claims are fraudulent.

He adds that fake documents, inflated values and repeated claims are the common types of fraud involving personal accident, travel and vehicles.

The GIA recently formed an Accident and Health Workgroup as it recognised the importance of tracking such claims and building a database. "One of the terms of reference is to study the travel insurance claims trend with specific focus on fraud," notes Mr Teo.

DUE DILIGENCE

If you think you can easily get away with dubious insurance claims, think again.

These so-called "soft fraud" cases can be hard to prove, but insurers won't turn a blind eye. Getting caught can mean your entire claim gets thrown out - and you get a black mark against your name.

Be aware that your claims are properly investigated. For instance, insurers check through past claims history to see if there is a pattern.

Insurers also maintain a list of customers who have chalked up frequent questionable claims. They then share information by submitting suspicious cases to GIA for circulation among member firms.

This alerts other companies so cross-checks of multiple claims by the same person can be carried out. At times, a common investigator, such as a loss adjuster, can be engaged by the insurers to help investigate and validate claims.

AIG's Mr Lowndes says the firm has an investigative unit to analyse, review and take action against false claims so that its claims team can process genuine claims more effectively.

When a claim is submitted, an insurance officer goes through the receipts and supporting documents provided by the claimant and checks the past claims history.

If there are no irregularities detected or no past claims history that arouses concern, the claim is processed and paid out.

"If we detect any irregularities which require clarification from the claimant, we will request more information," says Mr Lowndes.

"This can be done via phone or e-mail, or through a face-to-face meeting, depending on the nature and extent of clarification required.

"If there is sufficient evidence that a fraudulent claim has been submitted, the claimant will usually admit to it and offer to withdraw the claim."

Where necessary, AIG's claims officers may work with industry specialist loss adjusters with specific expertise to ensure that all aspects of the claims are reviewed and covered, especially in cases where there are major losses in the property and energy lines of business.

Ms Koh advises genuine claimants to substantiate their claims with relevant supporting documents. So original receipts and bills should be produced for medical treatment received overseas or in Singapore after the trip, while travel delay claims should be backed by an explanatory letter from the airline.

A property irregularity report should be completed at the airline counter for any claims for baggage delay or luggage damage.

And if you have personal effects or theft claims, a police report should be made in the country where the incident occurred. You should then produce relevant receipts so that the lost items can be verified.

 

  • 130%

    Increase in fraudulent claims seen by AIG between 2014 and last year

    30%

    Increase in fraudulent claims seen by Sompo over the past three years

    20%

    Estimated percentage of claims in Singapore that are fraudulent, according to GIA's chief executive

REAL-LIFE FRAUDULENT TRAVEL INSURANCE CLAIMS

Case 1: Multiple claims on same loss

Mr Daniel Lim (not his real name) filed a travel insurance claim for loss of checked-in baggage valued at $8,709 after visiting a nearby country. The insurer was informed by a loss adjuster that Mr Lim had filed similar claims with eight insurers concurrently.

During the interview by the loss adjuster, Mr Lim acknowledged that he had taken up eight travel policies. Separately, the airline had offered him a travel voucher as compensation.

Mr Lim subsequently withdrew his claim from the insurer and did not pursue his claims with the other firms as he had been confronted with evidence of multiple claims on the same loss.

GIA says: "As the reason to take up eight travel policies concurrently for a five-day trip to a nearby country is questionable, we have taken note of this person and will abstain from selling him travel insurance in the future."

Case 2: Two claims with the same receipt

Mr Tony Huang (not his real name) made a claim for $450 for a case that was damaged during his one-week trip to Taiwan last year.

AIG's claims officer raised an alert because of the frequency of claims submitted by Mr Huang. Investigations revealed that Mr Huang's travel partner had earlier submitted the same claim to AIG using the same receipt, and the claim had already been paid out.

The claims officer spoke to both people and they admitted that both claims were fraudulent. The first claimant withdrew his claim, while his travel partner made restitution to the insurer for $450. They also admitted to submitting similar fraudulent claims previously (again on the basis of damaged luggage), and made restitution for these.

Case 3: Wilful misrepresentation

Mr James Tan (not his real name) and his girlfriend travelled to Jakarta and visited a shopping complex.

He was carrying his sling bag at the time.

When he was about to pay for an item, he discovered that only the sling of the bag remained on his shoulder. The missing bag contained two Prada wallets, two cameras, two pairs of sunglasses, one Prada card-holder and $1,800 worth of cash.

But Mr Tan could not explain to Sompo's claims officer how the bag containing the items could have gone missing without him or his girlfriend noticing. He also could not recall the name of the hotel he had stayed at.

When the insurer wanted to speak to his girlfriend to obtain more information, Mr Tan decided to withdraw his claim.

Case 4: Wilful misrepresentation

Ms Peggy Chong (not her real name) travelled to Thailand to visit her brother, who was married to a Thai national.

She alleged that a pickpocket stole from her handbag while she was shopping at Pratunam market.

The handbag had been slung across her body but she could not explain how her Prada wallet, Samsung Note 4 and two Casio cameras could have been taken without her knowledge.

When Sompo's claims investigator asked that she make a Singapore police report to blacklist the missing Samsung phone and to speak with her brother to verify details, she declined to do so and refused to provide contact details. She subsequently withdrew the claim.

Case 5: Wilful misrepresentation

Ms Cindy Heng (not her real name) told AIG Singapore that her bag went missing after she was distracted by a pedlar selling souvenirs at a coffee shop while on a four-day holiday in Thailand last year.

She claimed $2,000 for the loss of a branded bag, several gadgets, including a mobile phone and tablet, and a branded purse that contained cash.

But it was found that the receipts, which she submitted for the lost items, did not belong to her.

When she met AIG's claims officer, Ms Heng admitted that she had carelessly left her bag behind at a coffee shop and only discovered the loss later on.

By the time she went back to the shop, the bag was gone.

She admitted that her bag was inexpensive and contained only an old mobile phone and some cash stored in an old wallet. The claim was rejected.

Case 6: Multiple claims for medical condition

Madam Low Ai Mei (not her real name) submitted a travel medical claim for $23,000 in November for an overseas trip which took place a month earlier. She reported that she had a "sprained back injury by accident" while in Taiwan. She was later hospitalised for three days in Hong Kong for a procedure.

GIA's review noted that Madam Low had a claim record with another insurance firm. GIA initiated a call and verified that she had submitted the same medical claim at about the same time.

GIA also found out that a third insurer had received a similar claim.

The evidence showed that multiple claims had been submitted for the same incident. GIA appointed an investigator in November. Madam Low was uncontactable on numerous occasions. After more than a month of non-response from her, GIA closed the file.

Case 7: Claim for pre-existing medical condition

Ms Linda Song (not her real name) reported to her insurer, AIG, that she chipped her tooth badly while having a meal during her holiday last year.

She alleged that she went for a dental implant at a random clinic the day after she returned from her holiday and that she had no known dental issues prior to this incident. She then submitted a claim for $7,200.

However, investigations revealed that Ms Song had made the dental appointment before her trip and that she had been consulting the dentist for years.

AIG also found that she had issues with the same tooth for a year before the trip.

The claim was rejected because of the pre-existing condition, which is excluded from cover under the travel policy she bought.

A version of this article appeared in the print edition of The Sunday Times on May 01, 2016, with the headline 'Fake claims soar as number of travellers rises'. Print Edition | Subscribe