Identifying and Reporting Insurance Fraud

More than 7,000 different businesses make up the insurance sector, which together brings in annual premium revenue of over one trillion dollars.

wad of hundred dollar notes

Because it offers more chances and larger incentives for engaging in illicit activities, the huge size of the sector is a significant contributor to the high cost of insurance fraud. Insurance fraud, including health and non-health insurance, is estimated to result in more than $40 billion in annual losses. This means that the expense of increased premiums caused by insurance fraud falls between $400 and $700 annually for the family in the United States.

If you have been a victim of insurance fraud, continue reading this article to find out how to report insurance fraud.

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Different Types of Insurance Frauds and How You Can Identify Them

Insurance fraud costs businesses and consumers tens of billions of dollars each year.

This affects both sides of the market equally. Regarding your insurance, taking shortcuts could end up being catastrophic and expensive for you. Consumers risk being left without legal coverage if they choose the least expensive policy that is still available without first investigating the agent or firm offering the policy. When something appears too good to be true, it almost always is.

There are four significant contributors to the problem of insurance fraud: fraudulent insurance companies, legal businesses that are not authorized to offer insurance, employees working in the insurance industry, and policyholders.

insurance fraud with calculator

Fraudulent Insurance Companies

Fake insurers collect premiums for bogus policies with no intention of paying claims. These fraudulent businesses typically make it difficult to get a hold of someone by phone and provide considerably reduced premiums. If you have been conned, this article will explain how to report insurance fraud.

Legal Businesses That Are Not Authorized to Offer Insurance

Companies that are legitimate but do not hold licenses to sell insurance often market their products, such as health discount plans, under the guise of being “insurance.” These products do not fall under the purview of insurance regulations.

Employees Working in The Insurance Industry

Fraud in the insurance sector can also be committed by members of the insurance industry themselves.

An example would be an insurance agent collecting customer premiums but not submitting them to the insurance company. The failure of the insurance companies to collect these payments results in the cancellation of the consumers’ policies or the refusal to renew them.

woman holding a tablet with insurance fraud written


Insurance fraud can also be committed by customers.

Consumer insurance fraud can take several forms, including the intentional staging of an incident that would be covered by an insurance policy (such as an accident, injury, theft, or arson), the exaggeration of a valid claim, or the provision of false information to an insurance company.

How Can You Protect Yourself Against Insurance Fraud?

Conduct Your Research Before Buying

It is important to remember to “stop and confirm” when dealing with an insurance company or agent you are unfamiliar with.


With how easy it is for scammers to acquire your data, it’s reasonable to be alarmed. Protect yourself and your loved ones by getting advice from experts. 

We will guide and even help you get your money back from scammers.

Be Mindful of Hidden Fraud

Even if you buy a legal product from a reputable insurance provider, you should still be on the lookout for telltale signals that an insurance agent or employee working for that organization is engaging in fraudulent activity.

Some of the warning signals include not receiving a copy of your insurance policy in a timely manner, being unable to get in touch with the insurance company or agent, and much lower premiums than expected. If you have issues or concerns, contact your company directly.

If You Suspect Fraud, Immediately Report It

Sheriff holding a phone

It is important to file a complaint with the Consumer Services Unit of the Division of Insurance if you suspect that you may be a victim of insurance fraud or if you are aware of an instance of insurance fraud. Suppose you believe that you may be a victim of insurance fraud or if you are aware of an instance of insurance fraud.

The Insurance Fraud Bureau (IFB) of Massachusetts is the specialized fraud bureau for the state of Massachusetts. The IFB is responsible for taking on cases in order to investigate them and get them ready for criminal prosecution.

Key Takeaways!

Adopting data solutions that shorten the amount of time required to spot fraudulent activity is one of the most effective methods for fighting fraud.

The development of new analytical technologies is necessary for the battle against fraud to stay up with sophisticated rings that always come up with new cons. Insurers are combining several methods in an effort to strengthen their fraud detection algorithms and achieve a higher level of precision.

Traditional methods, such as utilizing automated red flags and business rules, have been supplemented by predictive modeling and link analysis, which looks at the relationships between things like people, locations, and events.

Other ways include using automatic red flags and business rules. Before a payment is made, fraud can be uncovered with the use of a variety of methods, including artificial intelligence. These more modern tactics are utilized during the process of initially filing claims. Claims that appear to have aspects that could be called into question are flagged for additional investigation, while claims that do not appear to have such elements are handled routinely.

In 2016, only 27 percent of respondents indicated they used technology to combat underwriting fraud. However, in 2018, about 90 percent of respondents said they use technology primarily to detect fraud related to insurance claims, which is a considerable rise from 2016.

The most significant obstacle insurers face is the scarcity of information technology (IT) resources, which affects almost three-quarters of insurers, roughly the same as in 2016; after this obstacle comes challenges with data integration, with 76 percent reporting the difficulty, which is an increase from the 64 percent who reported the issue in 2016.

We hope this article helped you know how to report insurance fraud; for more relevant information, visit Ez Chargeback and find thousands of articles and guides that can save you money.

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