Insurance fraud

Research of the Dutch Association of Insurers (Verbond van Verzekeraars) shows that insurers are facing more and more insurance fraud. Van Traa Advocaten assists insurers in dealing with this insurance fraud. They advise on the possibilities of fraud investigations and handle fraud cases, both in and out of court.

Proving insurance fraud is not an easy task. The principle is that an insurer is required to prove the existence of fraud. The question is, how the intention to deceive the insurer can be proven. In cases where the insured does not acknowledge the fraud, the intent of the insured can only be proven by way of suspicions drawn from the facts and circumstances of the case. Whether or not these suspicions actually can be concluded on the basis of the available information is a complex issue, the outcome of which is very much dependent on the case.

Because of the far-reaching consequences of the assumption of fraud, the insurers are required to meticulously investigate suspicions of fraud. Extensive research needs to be performed to gain evidence, however insurers are facing numerous rules and regulations with regard to privacy that make this difficult.

At first, the investigation will usually consider the facts in more detail. Although this involves a review of the own data base, fraud registers and the Internet – especially social media , the processing of such data is governed by certain frameworks. A ‘fishing expedition’ is not allowed.

A more intrusive research method is the personal investigation, during which the person involved may be observed. Due to the privacy infringement involved, such an investigation is highly regulated. If the requirements are not met, the consequences may have great impact: the research results may be excluded from the procedure because they are deemed ‘unlawfully obtained’.

Our lawyers are very experienced in handling these evidence issues. They advise and litigate regularly in fraud cases and assist insurers in fraud investigation issues.

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