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FactCheck: Are 20% of personal injury insurance claims in Ireland fraudulent or exaggerated?

Members of the insurance industry have claimed that fraud is part of the reason for high premium costs.

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CHIEF EXECUTIVES FROM three of the largest insurance companies in Ireland have been scrutinised recently over statements they made to the Oireachtas. 

Representatives from FBD, Axa and Allianz said the companies had estimated that 20% of personal injury claims they receive are fraudulent or exaggerated. The three companies make up around half of Ireland’s insurance industry. 

They said these false or exaggerated claims are part of the reason insurance premiums are so high in Ireland. 

But is this statement true? Are fraudulent claims a big issue in the Irish insurance industry?

The Claim

Three Irish insurance companies each said separately that they estimated that approximately 20% of the personal injury claims they receive could be fraudulent or exaggerated. 

They stated that fraudulent claims are part of the reason for rising premium costs in Ireland, along with high legal fees and high court awards (particularly for whiplash claims).

The statements were made in an Oireachtas Finance Committee meeting on 4 July, during which Sinn Féin finance spokesperson Pearse Doherty questioned the representatives from FBD, Axa and Allianz.

A video of the exchange got more than half a million views on Twitter, as well as more than two thousand retweets and more than six thousand likes.

Going into more detail, Allianz CEO Sean McGrath said that the company looks into one in five cases for fraud or exaggeration, but not all of these would progress into a proper investigation. 

“We would see from investigations on our personal injury side that up to 20% of cases would have potential issues or potential signals that we would then have to look at to investigate further,” McGrath told the committee. 

Axa CEO Philip Bradley said the company has a fraud team of 18 people which investigates claims. A spokesperson for Axa told TheJournal.ie that they also have 60 former garda workers across Ireland who help investigate claims. 

“Last year, our fraud savings were just over 19 million which is about 4 and a half per cent of premium, but we don’t know what we didn’t find,” CEO Philip Bradley said in the Oireachtas.

“About 20% of claims have an indicator and about 10% of claims go to our specialist fraud team for further investigations.”

CEO of FBD Fiona Muldoon said exaggerated claims are “at least as big or a bigger issue” than fraudulent claims. 

“Lowering bodily injury awards in the courts will help with tackling fraud as well,” she said.

“We do estimate that fraud is about 20% of which we catch about half of it,” said Jackie McMahon, chief claims operator for FBD. 

“What we now have is claims coming in for cost of care for people with minor soft tissue injuries. They need people to do their gardening, they need people to do their domestic chores.

“That exaggeration is absolutely driving up the cost of the claim and the payouts,” he added.

Pearse Doherty pushed the insurance companies on these figures, noting that a total of 19 cases of fraud in the insurance industry were reported to gardaí between October 2018 and March 2019. 

Allianz reported 48 cases of fraud to the gardaí since June 2018. Axa reported over 50 cases since 2013. Both companies receive around 5,000 injury claims per year.

These reported cases of fraud relate to all areas, not just personal injury. 

The average award in Ireland for whiplash is approximately 4.4 times higher than that of the UK, according to the Government Personal Injuries Commission.

It was reported last month that profits at Irish insurance companies rose by more than 1,300% in 2017. The three companies at the Oireachtas meeting all saw profits rise well above targets in 2018. 

The evidence

So how did the insurance companies come to this figure of 20%? 

An exaggerated claim is any deliberate attempt to falsely increase the potential rate of compensation. This is usually done through an overstatement of injuries sustained, property lost or damages claimed. 

The definition of fraudulent and exaggerated claims differs between companies. Allianz defines a fraudulent claim as any deliberate attempt to seek compensation through criminal deception, misrepresentation or exaggeration.

 Axa says it is a deliberate act or omission upon which the company relies, undertaken with the deliberate intent of deceiving the company to gain financial advantage.

Head of marketing and communications at Allianz Insurance Damien O’Neill told TheJournal.ie that Allianz consider “any form of deliberate exaggeration to be fraud”. 

“We run sophisticated statistical analysis, in the background, on the 20% of exaggerated or suspicious claims to find those clusters and links connected with different families or areas,” said O’Neill. 

“Based on our assessment of claims notified to us we have concluded that approximately 20% of them have triggers identifying them as potentially fraudulent or exaggerated,” said O’Neill. 

Detected and undetected fraud is estimated to represent up to 10% of all claims expenditure in Europe, according to a report in 2013 by Insurance Europe, the European insurance and reinsurance federation. 

The report acknowledged that the figure varies between countries and types of insurance due to different factors. 

Allianz uses a group of fraud detectors led by former gardaí and systems support to analyse these claims. 

“Representatives of An Garda Siochana stated at the Oireachtas Committee that 50 cases of insurance fraud were reported by insurers in the past eight months,” said John Byrne, head of communications at Insurance Ireland. 

“In the UK, its dedicated Insurance Fraud Enforcement Department assess 380 cases on average each year so proportionally, more cases are being investigated in Ireland.” 

Byrne added that the 20% figure can be broken down into approximately 10% of cases involving potential fraud and approximately 10% involving potential exaggeration or indicators that would warrant a further investigation. 

FBD did not respond to questions about their reported cases. 

Insurance companies report suspected fraudulent or exaggerated claims to the gardaí for further investigation. In October 2018, the gardaí and Insurance Ireland issued new reporting guidelines for insurance companies who suspect cases of fraud or exaggeration.

All formal complaints are reported to the garda superintendent in the district the alleged offence took place, and insurance fraud was added as a separate crime category to the Pulse system in 2018. 

Insurance Ireland estimated in 2016 that the total annual cost of fraud to the Irish insurance industry is approximately €200 million. Around 50% of this is to the cost of motor. 

Verdict

The insurance companies provided us with details about how they suspect 20% of cases as being exaggerated or fraudulent claims – but they didn’t say how many of these actually turned out to be so. 

There is a large discrepancy between the low number of reported cases of fraud and exaggeration to gardaí and the 20% estimated figure stated in the instance of personal injury cases.

Allianz has reported 48 cases of fraud to the gardaí since June 2018. Axa  reported 50 cases since 2013. FBD did not respond on their reported cases. 

However, as the 20% figure is based on their internal audits for potential fraud, it is difficult to know how many suspected cases turn out to be non-fraudulent or exaggerated.

Many factors affect premium costs in the insurance industry and it’s impossible to distinguish the amount one factor affects the overall cost. 

Verdict:  UNPROVEN

As per our verdict guide, this means: The evidence available is insufficient to support or refute the claim, but it is logically possible.

The 20% figure could be true or false, but the three insurance companies in question did not provide the information to ascertain either way, and the information is not available elsewhere to back up their claim.

It should be noted that the claim has been made by three insurance companies, which account for around half of the insurance industry in Ireland. 

TheJournal.ie’s FactCheck is a signatory to the International Fact-Checking Network’s Code of Principles. You can read it here. For information on how FactCheck works, what the verdicts mean, and how you can take part, check out our Reader’s Guide here. You can read about the team of editors and reporters who work on the factchecks here.

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