Insurance fraud

Insurance fraud can take place in the private as well as in the commercial sector and can basically have the following characteristics:

  • Planned, intentional or culpable bringing about of an insured loss caused by the policyholder. In this case, it is claimed to the insurance company that the damage occurred as a result of an accidental event. The offence of § 263 par. 3 no. 5 StGB is fulfilled. According to § 81 (1) VVG, the insurance company is released from its obligation to pay benefits in such a case.
  • In the case of a fictitious damage, no damage has actually occurred, it is only feigned. Here, too, the insurance company has no obligation to pay benefits, since it only has to pay in the case of real damage and an insured event has not occurred. In this case, too, the offence of § 263 para. 3 no. 5 StGB is fulfilled; if applicable, there may also be the pretence of a criminal offence according to § 145d para. 1 StGB.
  • In the case of redefinition, a damaging event has occurred, for which, however, no insurance cover exists, so that a policyholder reports false event circumstances and fakes the occurrence of an insured event. This also falls under the elements of the offence under § 263 (3) no. 5 StGB.
  • In the case of exaggeration, there is an insured loss, but here it is feigned that the loss is higher than the actual loss.

The offence constitutes a criminal offence and is punishable by imprisonment of up to five years or a fine.

Artificially induced liability cases such as.

  • Intentionally caused traffic accidents
  • Altered representation of events
  • Exaggerations
  • Etc

There is no limit to the creativity of the perpetrators.

On behalf of insurance companies, we check whether asserted claims are based on true facts and create legally secure evidence.