Guidelines on Fraud Reporting & Claims

CONTACT:-
CALL:   1-300-22-11-88
E-MAIL:  FraudReporting@piam.org.my

HOW TO REPORT INSURANCE FRAUD

Insurance fraud is a crime. And far from being a victimless crime, insurance fraud victimizes every policyholders, costing consumers millions of ringgits in the form of increased premiums and higher prices for goods and services. The exact cost of insurance fraud is difficult to estimate because much of it goes unreported.

Therefore, PIAM introduces a dedicated channel to report any suspecting general insurance fraud that has been committed. Reporting fraud to us ensures that the correct crime reporting procedures are followed. You can report a fraud in general insurance to PIAM by submitting the Fraud Reporting Complaint Form (Click Here to download the form) and send it to us by using our online fraud reporting tools via our website or email to FraudReporting@piam.org.my. You may also call us at 1-300-22-11-88.

WHAT IS INSURANCE FRAUD?

Insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due.

The essential components of an insurance fraud are:-

  • Intent to deceive
  • Desire to induce insurance company to pay more than it otherwise would.

Examples of Insurance Fraud:

Creating a fraudulent claim:

Staged accidents – e.g. by ‘oil spillage’ or staged chain-collision – to get the custody of the vehicle(s) for repairs.

  • Bogus claim for an accident or injury that has never happened.
  • Claiming against a personal accident insurance policy for self-inflicted injuries.
  • Staged slip and fall accidents.
  • False claim of foreign object in food or drink.
  • Faking a death to collect benefits or filing a false death claim.
  • Staged burglary, theft or vandalism.
  • Arson.
  • Staged motor theft.
  • Staged homeowner accidents.

Overstating amount of loss

  • Inflated or ‘padded’ claim where the extent of damage or injury sustained in a genuine accident is exaggerated
  • Inflating value of items taken during a burglary/theft
  • Medical service providers inflating medical bills.

Misrepresenting facts to receive payment

  • Making multiple claims by having multiple insurance covers with different insurance companies for one vehicle and for a particular accident.
  • Claiming prior damage occurred in the current accident.
  • Claiming a partial or total disability for a minor injury.
  • Receiving disability payments while working elsewhere and conducting same or similar work duties.
  • Medical service providers charging for services not rendered.
  • Claiming false disability.
  • Medical service providers giving unnecessary medical treatment.
  • Charging for non-provided medical tests.

Bogus agents/Sale of forged cover notes

  • Sale of insurance by an unlicensed insurance company or someone purporting to be an agent of an insurance company.
  • Sale of forged cover notes by touts or organised syndicates to those who, knowingly or unknowingly, purchase the cover notes for the purpose of securing road tax for their motor vehicles.

HOW INSURANCE FRAUD AFFECTS YOU

Health is endangered
People’s health and lives are endangered by swindlers who sell non-existent health policies or perform quack medical care to illegally inflate health insurance claims.

Premiums stay high

Auto and homeowner insurance prices stay high because insurance companies must pass the large costs of insurance fraud to policyholders.

Consumer goods cost more
Prices of goods at your department or grocery store keep rising when businesses pass higher costs of their health and commercial insurance onto customers.

Honest businesses lose money
Businesses lose millions in income annually because fraud increases their costs for employee health coverage and business insurance.

Innocent people are killed and maimed
People die from insurance schemes such as staged auto accidents and arson — including children and entire families. People and even animals also are murdered for life insurance money.

Employees lose jobs
People lose jobs, careers and health coverage when insurance companies go bankrupt after being looted by fraud thieves.