The Way To Handle The Criminal–Civil Intersection In Insurance-Claim Cases

I. Common Criminal Offenses Encountered in Insurance Claims

Common types of criminal conduct seen in insurance claims include fraudulently obtaining indemnity payments, misappropriating surrender or reduction refunds due to policyholders, or under the guise of surety insurance defrauding banks and other financial institutions.

At the application stage, an applicant may fabricate the subject-matter of insurance or falsify underwriting documents. When a loss occurs, the insured may invent a non-existent event, concoct a fictitious cause, or intentionally bring about the loss. During the adjustment phase, the claimant may collude with "claim-hustlers" to inflate damages, forge loss certificates, or bribe adjusters, surveyors and property-valuers to supply false reports. On surrender or reduction of coverage, insiders may exploit the policyholder data and policy files under their control to embezzle the refund proceeds.