SGI released its list of top five insurance fraud cases on Monday as part of International Fraud Awareness Week.
The list includes false claims for breaking and entering, thefts and hit and runs. SGI investigated 1,234 suspicious insurance claims in 2019, denying claims worth a combined $10-million. Less than one per cent of all fraud claims are investigated by SGI in a typical year.
“Life is not like the movies, and real-life scams don’t always involve a gang of sophisticated career criminals conspiring to rip off millions from a smug casino owner,” reads an SGI press release. “Sometimes, it’s as simple as a person lying about an insurance claim, which ultimately leads to higher costs for everyone…. A fraudulent insurance claim can lead to denied coverage, but also has future insurance implications, and could even result in criminal charges.”
The biggest false insurance claim of 2019 was worth more than $228,000. A resident told SGI a number of large appliances were stolen from their home during a break-in. The resident also claimed their floor was damaged during the process.
SGI investigators were able to find photos showing a refrigerator was still present in the home. When the residents alleged it was a replacement, the investigator found photos from a year and a half before the incident, which showed the same fridge and the same floor. Police officers who investigated the case also noticed items reported as stolen that were still in the home.
In other cases, a resident parked their vehicle on the street, then claimed the windows and taillights were smashed in and the interior destroyed overnight. SGI investigators found no debris or footprints around the vehicle, and technical information downloaded from it showed a key had been used in it in the hours after the resident said they went to bed. The claim, worth around $44,000, was denied.
Other top fraud attempts included a pair of false claims from impaired drivers worth $24,000 and $10,000 respectively. One driver told SGI his car was damaged in a hit and run, while the other claimed he damaged it while swerving to miss a wild animal. The two incidents were unrelated.
SGI also tracked down the source of a fraudulent stolen vehicle claim. The resident told investigators the theft happened while she was far from home and she didn’t have a phone to report it. However, investigators later discovered a police report showing a vehicle matching her description had struck a bridge roughly 12 km away from where she said it had been stolen. Police also said they found her intoxicated and barefoot a few hundred yards away.
The resident originally claimed she walked home after her vehicle was stolen. When asked by investigators how she walked home barefoot, she said she was a fast walker. Her claim, worth more than $12,000, was denied.
SGI says the majority of people who file claims are honest and entitled to receive benefits. They also say investigators frequently discover that cases they look into are legitimate.