Policyholders are reportedly producing false stories and evidence for their claims
.jpg)
CEGA — a firm that provides global medical assistance, repatriation, travel risk management, and claims services — has found an increasing number of cases where insurance customers lie about circumstances of claims to increase the chances of a payout.
CEGA’s Special Investigations Unit has reported that customers who get their claims rejected change their stories, according to the International Travel and Health Insurance Journal. After getting denied, the policy holders cite different circumstances so that they are more in line with those covered in their policies.
“In the last year we’ve seen a rise in the number of customers submitting alternative, fabricated evidence to back up a claim,” said Simon Cook, CEGA’s head of technical claims.
“We’ve had cancelled holidays attributed first to passports not being renewed in time and then to illness,” Cook continued. Other cases involved claimants reporting that their bags were stolen while unattended — which would disqualify them from a payout — then changing their stories to say that the bags were being watched. Still others tried to claim for flights missed due to late passport renewals, only to claim later it was due to a tire puncture on the way to the airport.
According to Cook, claimants would often produce false evidence, such as retrospective sick notes and breakdown reports, to support their subsequent applications for claims. Such policyholders seem unaware that lying about a claim’s circumstances can warrant severe penalties.
“But we ensure that our claims processes quickly pick up these scams and that claims handlers are trained to use sophisticated conversation management techniques to make sure that genuine claims are paid quickly and fraud trends are exposed,” he said.
Related stories:
Regulators slam travel insurance industry over questionable practices
Langley man survives major accident in Thailand, but faces huge medical bill
CEGA’s Special Investigations Unit has reported that customers who get their claims rejected change their stories, according to the International Travel and Health Insurance Journal. After getting denied, the policy holders cite different circumstances so that they are more in line with those covered in their policies.
“In the last year we’ve seen a rise in the number of customers submitting alternative, fabricated evidence to back up a claim,” said Simon Cook, CEGA’s head of technical claims.
“We’ve had cancelled holidays attributed first to passports not being renewed in time and then to illness,” Cook continued. Other cases involved claimants reporting that their bags were stolen while unattended — which would disqualify them from a payout — then changing their stories to say that the bags were being watched. Still others tried to claim for flights missed due to late passport renewals, only to claim later it was due to a tire puncture on the way to the airport.
According to Cook, claimants would often produce false evidence, such as retrospective sick notes and breakdown reports, to support their subsequent applications for claims. Such policyholders seem unaware that lying about a claim’s circumstances can warrant severe penalties.
“But we ensure that our claims processes quickly pick up these scams and that claims handlers are trained to use sophisticated conversation management techniques to make sure that genuine claims are paid quickly and fraud trends are exposed,” he said.
Related stories:
Regulators slam travel insurance industry over questionable practices
Langley man survives major accident in Thailand, but faces huge medical bill
