Episode 7 - Part 1
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Welcome to Risk Matters, the insurance podcast brought to you by DWF and your
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global guide to the latest trends and issues in the insurance and reinsurance industry.
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Join us as we explore topical issues, emerging technologies and the innovative
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strategies that are shaping the global future of insurance.
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Welcome to Risk Matters, the insurance podcast from DWF.
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Today we will be talking about tackling insurance fraud in Europe.
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My name is Lorraine Caroline. I'm the Global Head of Fraud at DWF and I'm delighted
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to be joined today by Ben McBean,
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who is the Assistant Claims Manager for QBE International and a key member of
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QBE's multi-award winning Special Investigations Unit.
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Also, Romain Dupre, a partner at DWF in France, and Endre Malley,
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an associate of DWF in Italy.
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So turning to our first question, and I'll put this to you, Ben,
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what are the main fraud risks and trends currently observed in Europe?
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Hi, thanks for having me today. One of the things that we find is a major issue
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at the moment is to do with synthetic identities,
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so where criminals are utilising aspects of a genuine person's identity and
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trying to use that as part of setting up a claim or a policy.
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So they'll make documents such as driving licences and that sort of thing to
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make a fraudulent claim.
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We're also seeing issues with commercial entities
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that are being utilised by organised criminal
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gangs so where you don't
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have a lot of transparency around corporate structures
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it's really difficult to identify when
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there's a problem so there's instances
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such as cargo fraud and theft
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of plants and cargo and that sort of thing they're utilising false entities
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that are being created specifically for creating the fraud so that's a major
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problem at the moment Thanks Ben, same question to you Roman.
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Bonjour Lorraine Very happy to be with you today.
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I think as a general matter, I would say that the French market is not as mature
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as the market in the UK in fighting insurance fraud.
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So there is a tendency by
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many interests to be more careful now because
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there has been a witness of encountering more fraud recently and that's true
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in many different markets that's true for construction I'll come back to that
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later for the car and motor industry and as well as the marine claims I would say,
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And over to you, Andre.
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As Roman said, in Italy, the market is even less mature than France with respect to insurance fraud.
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And when discussing insurance fraud in Italy, the focus tends to be on the motor sectors.
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These for two main reasons. The first one is that we have official data only
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in respect with motor third-party insurance liability.
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And the other one is that motor sector accounts for 70% of the fraudulent claims in Italy.
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However, in the most recent years, we are facing an increase across all the
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different lines of business.
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For example, life, personal injury, theft, transport, medical malpractice.
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And another quite concerning aspect that also Ben was highlighting is that the criminals gang,
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organized gangs, are showing more and increasing interest in insurance fraud activities. Thank you.
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Ben, what are the most common types of insurance fraud seen in your market and
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can you share any examples?
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If I look at the types of things that I see the most, I see a lot of opportunistic fraud in Ireland.
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People making personal injury claims that are exaggerating the extent of the
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injury. So there's quite a lot of that in Ireland.
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From an organised perspective, as I mentioned, the challenges around cargo fraud,
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people using false identities to get into the supply chain.
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There's also construction people involved in stealing plant,
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potentially for it to be taken to Ukraine, Gaza those sort of places,
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we also see instances of
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stage thefts in hotels whether
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it's criminal gangs who are operating in a hotel to steal the belongings of
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genuine people or also using alleged thefts as ways in which they can mask money laundering.
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They'll say that they had a certain amount of money and...
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Expensive possessions stolen so they can make a claim, which then turns their
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dirty money into clean money as well.
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So there's quite a variety of things that are going on in Europe that I see.
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Indeed. And passing over to Italy, Andre, same question.
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Well, in Italy, I would say that the most common type of insurance fraud are
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in the modern sector, and they typically occur in high-frequency, low-value cases.
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As I was saying before, as I mentioned before, we have seen an increase in the
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recent year in other kind of businesses, especially personal injury and road accidents,
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property damage, and vehicle theft, which are quite expanding in the recent years.
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And I would like to share you an example of insurance fraud claims that grabbed
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the headlines of the leading Italian newspapers.
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Because quite recently, in
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2019, a criminal organization, which was composed of at least 34 members,
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was specialized in insurance fraud carried out through the mutilation,
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the deliberate mutilation of claims of compliant victims. And it was a very important thing.
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And this is an example that I want to share because it is one of the first times
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that an insurance fraud activity had been dealt with also by the national newspapers.
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Because as I mentioned before, in Italy, our market is not as mature as it is in the UK and in France.
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We have also many cultural aspects involved in this.
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So it is important for Italy that fraudulent activities are advised.
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So as I was saying also before, this is an aspect which is quite relevant because
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we do not want criminal organization and gang members to put their hands also
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on insurance fraud activities because they have almost unlimited access to money,
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to artificial intelligence technologies,
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Over to you in France, Roman.
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One of the most common areas for insurance fraud is the construction industry.
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As I mentioned, in France, construction companies need to have a number of mandatory
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coverages to carry out their activities.
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For example, decennial warranty or the coverage of reimbursement of advances, etc.
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And when some of these businesses cannot find this kind of coverage,
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they tend to forge insurance certificates, either to use certificates they had
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in the past or to use third-party insurance certificates to pretend they still
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do benefit from this mandatory coverage.
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So that's a kind of case where I can turn on a weekly basis for our clients here.
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So the construction industry is really very exposed to insurance fraud.
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I would say there is another sector which deserves specific attention,
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which is insurance intermediaries, because in a number of cases,
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insurance intermediaries are not very transparent on the information they receive
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from the insured and do not always transfer them accurately to the insurance.
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And try in the meantime to make money on the premium or to take commitments
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that insurers are not aware of.
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Ben, we all know that data is so important to detection of fraud.
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How comprehensive is the data on insurance fraud in your jurisdiction?
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For which insurance lines is data collected? And do you think there's more that
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we can be doing in this area?
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Yeah, I think if you look at the data that we get from the IFB.
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There's quite a lot of data around certain lines.
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So you get a lot of data around motor accidents, casualty claims,
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property, a bit on travel and that sort of thing.
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But generally, I think data is quite poor when it comes to commercial lines
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of business and particularly cross-jurisdictional data as well.
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It's quite hard to get data when exposures are in other jurisdictions,
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and particularly with specialist lines of business as well.
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So if you're looking at marine or something like that, it's very difficult to get that data.
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So there could be a lot more done there.
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And I think one area that was highlighted recently when I was listening to the Lamptience podcast.
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They were trying to do an evaluation of the trend
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of EV thefts and comparing
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that to other vehicles and seeing why it might be different but the problem
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they had was that there just wasn't the quality of the data there even though
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it was a motor line of business they still didn't have the data So I think there's
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an awful lot that needs to be done in that regard.
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And it's interesting that you say that, you know, it's in the mainstream,
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sort of the property casualty motor areas that we've come on an awful lot with
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the collection of data, but not so much in the commercial lines.
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Over to Roman, where is France in all of this?
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I think in the UK, the overall amount of fraud is about 5 billion, right?
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So the amount of identified frauds, if I'm correct, Lorraine or Ben.
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I think in France, the latest data we have come from the Alpha,
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the Association for Fighting Intrance Fraud.
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It dates back to 2024.
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And according to them, the total amount of fraud in France was 900 million euros.
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Including $650 million for casualty and property, and the rest of it,
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about $250 million for life insurance and health insurance.
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So it leads me to believe that the data in France is not totally accurate because
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I can't see that the amount of
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fraud in the UK could be five times more important than it is in France,
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and there's still a huge challenge in trying to collect the data.
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Another interesting data I came across was the data from Belgium in which fraud
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went up from 6,000 to 7,000 cases according to Asuralia, the Belgian Insurance Association.
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So I think the rise in insurance fraud is not specific to one jurisdiction in
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continental Europe, but it's a more general trend.
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And according to the French Insurer Association, that would represent about
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3% to 4% of the amount of the indemnities paid over a year.
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And Roman, can I stay with you on that? Because you talked about,
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you know, the data may not be accurate.
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And that's obviously a very big challenge. So what are the challenges around
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collecting and sharing the fraud data across Europe and the UK?
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I think the system for going after fraud is very different in each jurisdiction.
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So that's why it has impact on the overall view you can have on the data in this respect.
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You tell me what is it in the UK, in France, you have to file a criminal complaint,
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for example, if you have identified an insurance fraud.
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And until very recently, this was a quite formalistic process.
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So many of the insurers didn't want to go through that process for each case
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they identified so that's why we have a whole part which is actually below the radar.
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And actually according to new reforms you can now file a criminal complaint
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online and I'm hopeful that it will help the process for insurers to actually
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raise issues in relation to fraud and also to have more digitalized data to
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dig through in the future.
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So if you have many, many different data about fraud, for example,
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you can see that it affects more regions than another specific category of vehicle, as Ben mentioned.
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And that would indeed help after that in having a red flag at the time of managing losses, etc.
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And Ben, any views or observations on what Roman's just said? Yeah, absolutely.
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I think fundamentally the issue is that if you don't have the data,
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then the legislators don't understand the extent of the problem and therefore
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not give sufficient priority to different legislation or strategies to deal with insurance fraud.
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So this area is really important.
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And one of the things that's been mentioned, I think, is in relation to the
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way in which data is captured.
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So in England and Wales, we can provide data on suspected fraudsters.
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We can have proven fraud, but proven fraud might be different to proven fraud in France.
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So when you're looking at sharing data, one of the problems is around the uniformity of the data.
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So are you measuring fraud by the same yardstick?
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Are you calling it the same names exaggeration or staged or what have you do,
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Are you able to compare it like for like because it's measured in the same way?
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But I think until we're able to capture that type of data, I don't think that
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the full extent of fraud in the UK and Europe will be fully understood.
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Agreed. And Andre, what's your view from Italy?
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I wanted just to add something about this because I think the real key point
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of all this discussion is the gathering of data, as Ben and Roman were saying.
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And a problem that we're facing in Italy is that insurance companies are currently
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highly investing on advanced tools, so intelligence, artificial intelligence.
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But if we do not have uniform datas and good quality datas, also these investments
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have no real impacts on counter-fraud activities.
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So I think this is the key point that we must.
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Advertise in the coming years at an international level, not just at a national level.
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And Ben, do you think that it's going to be possible to have that uniformity
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across all jurisdictions?
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I think at the moment, probably not.
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As I say, I don't think that different countries
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um possibly appreciate the
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extent of fraud and how it's impacting customers
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um so yeah it's
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quite tricky like i said it's a bit of a catch-22 um um
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you need to um try and explain the problem but you don't have the data to do
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it but yeah it's very tricky but um i think there's a lot of will um when you
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speak to different insurers in different countries um people are work in our
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field in fraud detection.
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Everyone's got the will to work together and to do something about it.
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So hopefully that means that we will get a bit closer to joining up a bit more in that regard.
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And staying with your point. Apologies, Lorraine. In this respect,
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there is a very interesting recent survey conducted by ANIA in Italy.
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We show that 72% of respondents here in Italy believe that there is no correlation
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between the insurance premium that they pay and fraud.
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So only 50% of respondents understands that the honest policyholders are paying
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also for those who defraud insurance companies.
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So just to give you some numbers and an idea of the differences between countries,
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I think in the UK the numbers are.
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Very, very different from the ones I just showed you.
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So this to me confirms that there
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is still much to do to have uniform data between different countries.
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Yeah, agreed. And just picking up on the point about sort of impact and regulatory
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impact on fraud detection and collaboration,
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How do the GDPR and data protection regulations, in your view,
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impact the detection and collaboration in your jurisdictions?
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And I'll go to Romain first in France.
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So there is an obvious contradiction between the rules on the protection of
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personal data and the need to process all this data by insurance to fight fraud.
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Actually, in France, it was handled by way of a decision of the CNIL,
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the authority in charge of overseeing rules on data protection,
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quite a long time ago, because it was in 2014 that the CNIL issued an opinion
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actually classifying the fight against insurance fraud as a legitimate purpose
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for processing personal data.
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So there is a legal basis for insurers to actually process personal data they
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collect to make sure they are efficiently fighting insurance fraud.
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Of course, this is subject to a number of coverets and rules and restrictions,
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but they are allowed, for example, to cross-reference their different databases,
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etc., and to create actually a list of suspicious insurers on the basis of this regulation.
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So there is a way for insurers to use this, of course, with some regulatory framework.
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And Ben, in your view…,
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Yeah, I think from an outsider's perspective,
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it seems to me like even though GDPR comes from the same European directives,
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we've all applied it seemingly quite differently in the way that it's actually
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utilised in day-to-day life.
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When you look at it, a lot of them read the same,
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but it seems culturally there's a lot more reticence to investigate who an individual
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might be or that sort of thing because of a fear maybe of an information commissioner.
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I think it was quite useful in the UK that we had a note from our Information
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Commissioner to remind people that they are allowed to investigate entities
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for prevention of fraud.
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Um so that was really good but there are
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jurisdictions that i see where um even the the basic kyc checks are difficult
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because they're concerned about um infringing somebody's uh personal rights
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when in fact also you you are protecting customers by by doing that and i think um.
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I dare say in the UK, I think we've got a really good balance there.
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I don't feel like we have our hands tied when we're trying to investigate thoroughly,
00:22:30.601 --> 00:22:35.021
but still we are reminded of our responsibility to protect our customers' data as well.
00:22:35.201 --> 00:22:40.021
So unless we're able to get past that, I think it really hinders the ability
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to properly investigate and also share data. So it's quite a big problem.
00:22:46.481 --> 00:22:49.761
Andre, your view from the Italian perspective?
00:22:49.761 --> 00:22:52.821
From an italian perspective i feel
00:22:52.821 --> 00:22:55.681
like we have not the same balance that ben
00:22:55.681 --> 00:22:58.581
was talking about when referring to to
00:22:58.581 --> 00:23:01.681
the uk because actually the italian guarantor
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of privacy is interpreting and applying the gdpr in quite a strictly way and
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in my view these the constraints are directly affecting fraud detection in italy
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we have data minimization we have purpose limitation We have further retention limits.
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And for a country like Italy, which, let me say, has not such a culture,
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such an experience when it comes to counter fraud, this is quite, quite limiting.
00:23:34.741 --> 00:23:39.601
So I think also from a legal and legislative perspective, there is much more
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to do in our country in the coming years.
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Of course, there are also European concerns, so it does not depend so lately
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on Italy, but I think this is one of the further key points that we will have
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to work on in the upcoming years.
00:23:55.901 --> 00:23:59.661
Thank you for listening to Risk Matters, the DWF insurance podcast.
00:24:00.041 --> 00:24:03.321
We hope you join us again soon for future podcasts in our series.
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