Reporting Fraud in Property & Casualty Insurance

Introduction:

The Company for Cooperative Insurance (Tawuniya) is committed to provide the highest quality services through ethical and fair practices for both its employees and business partners. One of the principal objectives of the company is to protect all parties involved in Property & Casualty insurance from fraud or abuse, which results in negative effects on insurance rates and thus increase the premiums payable by insureds to cover the losses resulting from such fraud. In fact, Property & Casualty insurance fraud operations affect everyone including you. Therefore, you find here all you need to know about Property & Casualty insurance fraud, its definition, FAQ, the difference between fraud and errors, examples of fraud and its consequences, and ways to prevent fraud or abuse of Property & Casualty insurance, and how to report these suspicious operations to Tawuniya.

Definition of Property & Casualty Insurance Fraud

Property & Casualty insurance fraud is any intentional act committed by one of the parties in the insurance contract to obtain undue indemnities or benefits to them or to others through deception and/or concealment of required documents and/or misrepresentation of information.

Examples of Property & Casualty Insurance Fraud

  • Misrepresentation of material facts might occur if an insurance proposer makes a false statement with the intention to deceive the insurer in order to obtain an unlawful gain, e.g. a discount on premium.
  • Inflated Damage/Loss of property. This may occur after a fire incident and an insurance claim gets filed.
  • Arson for Profit, dwellings or commercial properties are destroyed by fire for the sole purpose of financial gain.
  • A claim is filed for a boat that sank, but the boat never actually existed. It is not difficult to register a boat based on a bill of sale.

Negative Effects of Property & Casualty Insurance Fraud

  • High premiums.
  • Claim process duration increased due to investigations.
  • Increase the deductible.

Mechanisms of Detecting Property & Casualty Insurance Fraud

  • Application of a sophisticated fraud control information system.
  • Cooperation with regulatory bodies such the Saudi Arabian Monetary Authority (SAMA).
  • Designation of a special email to report fraud managed by the team of the anti-fraud unit.

Preventing Property and Casualty Insurance Fraud

As a valuable member and a key source to help us deal with fraud in Property &Casualty insurance, you can participate in preventing and combating these fraudulent operations by reporting any suspicious acts through the below available channels.

Rewards for Reporting Property and Casualty Insurance Fraud

Tawuniya pays a financial reward to the individuals who report proved and confirmed frauds in accordance with the Company's approved policies and procedures.

Confidentiality of Information

The Company for Cooperative Insurance (Tawuniya) pledges to maintain the confidentiality of information / material related to fraud / misuse that it receives or maintains, as well as the confidentiality of the information of the person who reports insurance fraud. It will only be disclosed to the supervisory authorities and parties involved in the case who need to review it if necessary.

Methods of reporting Property & Casualty insurance fraud?

If you suspect or have seen a fraud case, please notify Tawuniya through:

Property & Casualty Insurance Fraud Form

Property & Casualty Insurance Fraud Form

Property & Casualty insurance fraud is any intentional act committed by the policyholder or a firm insured by Tawuniya to obtain undue indemnities or benefits to them or to others through deception and/or concealment of required documents and /or misrepresentation of information.
Fraud may occur from any person involved in Property & Casualty insurance process, for example, insurance policy holders or any other party to avail of from the policy for unrightfully obtaining a compensation. Nevertheless, Tawuniya respects its clients and observes the principle of trust with both customers and partners. However, fraud can be committed by persons in various occupations and jobs, the policy holders, employers or insured enterprises.
It is a unit within Tawuniya that is responsible for investigating fraud and abuse of the company's services, and discovering potential operations using special fraud control systems. The Unit also monitors suspicious operations by policyholders, customers and other parties. In addition, the unit cooperates with the regulatory authorities such as The Administrative Investigations and SAMA.
Yes of course, Tawuniya pays a financial reward to the individuals who report proved and confirmed frauds in accordance with the Company's approved policies and procedures.
As a valuable member and a key source to help us deal with fraud in Property &Casualty insurance, you can participate in preventing and combating these fraudulent operations by reporting any suspicious acts through the below available channels.

If you suspect or have seen a fraud case, please notify Tawuniya by:

It is very important to distinguish between fraud and unintentional error in Property & Casualty insurance operations. In fraud, a person deliberately deceives the company by the misrepresentation of material facts, or by non-disclosure of the required information, resulting in financial damage to the company, its customers and partners in one way or another. Simply, fraud is to get something valuable through deceptive/ fraudulent means.

On the other hand, errors come from people when they provide false information without their knowledge and unintentionally. In other words, this act is called unintended error.

Therefore, Tawuniya recommends that everyone should peruse the Insurance Consumer Protection Principles for more information on the insurance policies issued by Tawuniya.

  • Misrepresentation of material facts might occur if an insured person makes a false statement with the intention to deceive the insurer in order to obtain an unlawful gain, e.g. a discount on premium.
  • Inflated Damage/Loss. This may occur after a fire incident and an insurance claim gets filed, where contents are included in the inventory of the damaged properties, even though they did not exist when the fire occurred.
  • Arson for Profit, dwellings or commercial properties are destroyed by fire for the sole purpose of financial gain. Insureds sometimes act alone or in concert with agents or highly organized crime rings specializing in arson.
  • Paper Boats, a claim is filed for a boat that sank, but the boat never actually existed. It is not difficult to register a boat based on a bill of sale. After a period, a loss is claimed for the sinking of the boat. It is difficult to prove that the boat did not exist or was sunk intentionally.

We, at Tawuniya, continue our efforts to strengthen our systems and controls to ensure that fraud is detected, prevented and minimized the foreseen adverse effects to our loyal customers like you. We also believe that it is the duty of all parties to help us face fraud. Our actions include the following:

  • Application of a sophisticated fraud control information system.
  • Cooperation with regulatory bodies such the Saudi Arabian Monetary Authority (SAMA).
  • Designation of a special email to report fraud managed by the team of the anti-fraud unit.

You, as an honest and responsible person, can be adversely affected by the fraudulent acts in property & casualty insurance in several ways. For example, you could encounter:

  • High premiums.
  • Claim process duration increased due to investigations.
  • Increase the deductible.
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