A Video Explaining the Three Major Responses to Insurance Fraud

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A Video Explaining the Three Major Responses to Insurance Fraud

See the full video at https://youtu.be/P2wMCMkoIDM

Insurers are faced with three major types of insurance fraud:

  1. Fraud in the inception of a policy of insurance.
  2. Fraud in the presentation of a claim by the insured.
  3. Fraud in the presentation of a claim by a third party claimant.

Fraud in the Inception

The insured misrepresents or conceals facts material to the decision of the insurer to insure or not insure the prospective insured. This is a situation where the person seeking insurance deceives the insurer about the risks it is being asked to take.

If the insured lies in the application for insurance about a matter that would have, had the truth been known, affected the decision of the insurer, the insurer may have the right to rescind the policy, determine it never existed, return the premium, and deny the claim presented by the insured;

Fraud (By the Insured) In the Presentation of The Claim. 

The insured lies about a fact material to the decision of the insurer to pay or not pay a claim. The insurer faced with a fraudulently presented claim can deny the claim in accordance with the policy provisions or declare the policy void and deny the claim; and

Fraud in the Presentation of a Claim by a Claimant Against the Insured. 

In these cases, the third party claimant makes a false and fraudulent claim against the insured.

In all three categories of insurance fraud the insurer is faced with the same challenges:

  • how to thoroughly investigate fraud and
  • how to prove that the fraud is a valid ground for denying a claim.

The author has also written a major work on insurance Fraud, Insurance Fraud & Weapons to Defeat Fraud available at Error! Main Document Only.http://zalma.com/blog/insurance-claims-library/and amazon.com.


© 2020 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921

Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts

Listen to the Podcast: Zalma on Insurance https://anchor.fm/dashboard/episodes Zalma on Insurance

Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/

Go to the Insurance Claims Library –https://zalma.com/blog/insurance-claims-library/

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