Global Solution Providers   *  Advisory   *   Anti-Fraud Training   *   Certifications

Life Insurance Fraud

  

ALERT!

 

 

Article marked FRAUD ALERT is for the close attention of the readers, particularly Claims Examiners and Special Investigators in Special Investigation Unit (SIU) of insurance companies worldwide. This is to alert them to what we have noted is a pattern or trend in recent claims and to be circumspect in countenancing such circumstances should similar claims be presented to their office.

travel insurance fraud investigation

Pilgrimage to cash US$9.8 million!

 

INDIA / UNITED STATES - Insurers are often at a huge disadvantage in countries where corpses are cremated. The culture and tradition may require that corpses be cremated within hours and forbid that they be preserved until the insurers are through with the claims. The challenge is therefore ever present for global insurers to fashion a means to resolving such a situation otherwise they would continuously be taken for a ride.


travel insurance fraud investigation

Sister spills the beans!

 

SIERRA LEONE / UNITED STATES - The attitude of Africans not to involve their siblings when they take out life insurance policies on their parents is in contradistinction with our experience with claimants or beneficiaries from Asia. The experience with Asian nationals inthe United States is that the siblings and relations band together and pool resources to pay the premiums over the years or for the duration of the policy.For instance, Chinese nationals, particularly those from Fujian Province,always band with their siblings and even their adult children as jointbeneficiaries. In one of the cases we investigated in China on behalf of a major US life insurer in 2016, the amount of the policy was US$2 million. Thepolicy beneficiaries comprised three siblings and their three adult children,altogether 6 family members. Thus, all the children of the lady and her grandchildren, all chefs, took out the life policy for US$2 million and simultaneously contributed to pay the premiums.


travel insurance fraud investigation

Declared ‘wife’ dead for US$40,000.00!

 

NIGERIA / UNITED STATES - The investigation had indeed been well wrapped up. We only required to have the claimant provide us a detailed statement. But we reasoned that if we ask him to merely make a statement in writing and e-mail to us, he would be evasive in providing us the salient aspects of the case. In particular, we feared he may not state that the corpse was allegedly recovered after two weeks and buried, the same information her so-called brother in Nigeria had passed to us when we spoke with him from the United States.


travel insurance fraud investigation

AIDS condition concealed for US$150,000.00!

 

UGANDA / UNITED STATES - In the course of investigations in Uganda, we were not in doubt that Mr. Mugila indeed died. However, death had occurred within two years of his taking the life insurance policy, a period which in the United States insurance practice is dubbed a contestable period. A contestable period is that in which the insurer can contest whether all the facts about the life insurance applicant or policyholder were disclosed to the insurer or not. If there is determination that the policyholders had not disclosed all the facts about themselves or concealed material information such as their medical condition or even misrepresented the facts, then the insurer is at liberty to opt out of the policy and refuse payment on any claim.


travel insurance fraud investigation

The fire for US$5 million!


GHANA / UNITED STATES - Mr. Koffi cultivated the friendship of the village Chief and important personalities in the town of Nsawan including a businessman who operated a business center, where people could go and make phone calls, locally and internationally, for a charge. Mr. Koffi not only spoke English with American accent but he did so quite well that when he fooled his friends that he was an African-American who decided to return “home” and live in their midst they believed him. None of them knew that he was a Ghanaian!


travel insurance fraud investigation

Fake funeral service and empty coffin!


HAITI / UNITED STATES - Analysis of a fraudulent life insurance claim originating from Haiti filed with a United States insurer in order to collect US$25,000.00. The video coverage of the funeral ceremony was complete with ‘body’ in an open casket placed in the church and a retinue of pastors in attendance up to the cemetery and actual burial of a coffin that turned out to be empty.


travel insurance fraud investigation

The conniving pathologist!

WEST AFRICA / UNITED STATES - We first  noticed  what  appeared  to be  a deliberate  effort  on the  part  of this pathologist to deceive us into believing the policyholder was hospitalized at the teaching hospital in the West African country following injuries she sustained in a lone motor vehicle accident which led to her death on December  24, 2013. The policyholder  was allegedly  admitted on December 16, 2013. In other words, she was treated at the hospital for 8 days before she expired. The pathologist at the teaching hospital allegedly conducted a post-mortem examination and completed the post-mortem  report and the medical certificate attesting that the policyholder died owing to "acute  left ventricular  failure and multiple injuries compatible with road traffic accident."

 


travel insurance fraud investigation

Some Red flags of fraudulent accidental death claims

GLOBAL - These days we are seeing increase in fraudulent accidental death claims. The reason could be that fraudsters target this form of life insurance cover because it is easy to purport that the policyholder died owing to injuries. It may also be because it is relatively easy for them to convince unscrupulous physicians to provide them with medical certificate affirming death.


travel insurance fraud investigation

How two fraudulent death claims' investigations were botched: Examples of how not to investigate foreign death claims


CAMEROON, GHANA / GLOBAL - There is  no doubt  that  owing  to the  combination  of several  factors  such  as globalization, upsurge in foreign claims and dearth of professional insurance fraud investigators, the natural course of event is that all manner of persons now register companies and tout abilities to investigate foreign life, health and travel insurance claims.  However, as the common saying goes, the taste of the pudding is in the eating!


travel insurance fraud investigation

Common life insurance fraud schemes


GLOBAL - False documentation arises when the claimant has submitted bogus documents as proofs to support the claim such as under life insurance or accidental death claims. Under these policies, the Examiner would seek the claimant provides, where applicable, documentary evidence of death such as the medical certificate, death certificate, police report, airline ticket, etc. The documents are presented as bona fides issued by the respective agencies purporting to have prepared them. However, in the course of on-the-spot investigation it would be found that the entire documents were false on one of the following premise.