Insurance fraud

Insurance fraud can take place in both the private and commercial sectors and can basically take the following forms:

• Planned, intentional or culpable causation of an insured loss caused by the policyholder. In this case, it is claimed vis-à-vis the insurance company that the damage was caused by an accidental event. The facts of § 263 Para. 3 No. 5 StGB are fulfilled. According to § 81 Para. 1 VVG, the insurance company is released from its obligation to pay benefits in such a case.
• In the case of fictitious damage, no damage has actually occurred, it is only feigned. Here too, the insurance company has no obligation to pay benefits, as it only has to pay in the event of real damage and an insured event has not occurred. Here too, the elements of the offense under § 263 Para. 3 No. 5 StGB are fulfilled; if necessary, the faking of a criminal offense under § 145d Para. 1 StGB may also be present.
• In the case of redefinition, a loss event has occurred for which there is no insurance cover, so that a policyholder reports false event circumstances and feigns the occurrence of an insured event. This also falls under the elements of § 263 Para. 3 No. 5 StGB.
• In the case of exaggeration, there is indeed an insured loss, but here it is pretended that the loss is higher than the actual loss.

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

Examples:
Artificially induced liability cases such as

• Intentionally caused traffic accidents
• Changed presentation of events
• Exaggerations
• Etc

There is no limit to the creativity of the perpetrators here.

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