Insurance Fraud Australia: The Law | Lyons Law Group (2024)

Table of Contents

  • What Is Insurance Fraud?
  • Is Insurance Fraud Criminal and Civil offense Australia?
  • Car Insurance Frauds Punishment Australia
  • Legal Advice for Fraud Charges

Insurance Fraud Australia: The Law | Lyons Law Group (1)

Insurance fraud is a serious issue that affects individuals, businesses, and the insurance industry as a whole. In Australia, like in many other countries, insurance fraud can take various forms, from exaggerating claims to deliberately causing accidents.

Each state and territory in Australia has laws pertaining to unlawfully obtaining property or a financial gain through dishonest means. This encompasses actions classified as fraud, deception, or dishonestly acquiring a financial advantage. Such infractions are grave in nature and may lead to substantial periods of incarceration.

What Is Insurance Fraud?

Insurance fraud refers to the deliberate act of providing false or misleading information to an insurance company with the intention of receiving undeserved benefits or financial gains. This can involve making false claims, exaggerating losses, staging accidents, or even deliberately causing damage to property or vehicles.

Types of Insurance Fraud in Australia

False Claims

False claims involve providing fabricated or exaggerated information to an insurance company to receive a pay-out that is not rightfully deserved. This can include inflating the value of lost or damaged items or falsely reporting non-existent damages. Such false claims or false statements could lead to the involvement of law enforcement.

Staged Accidents

Staged accidents occur when individuals intentionally cause accidents or collisions to make it appear as though the incident was an unforeseeable event. This type of fraud often involves multiple parties colluding to maximise the insurance pay-out.

Arson and Property Damage

Deliberately setting fire to property or causing damage with the intent of filing an insurance claim for the losses incurred is considered a serious form of insurance fraud.

Identity Fraud

Identity fraud involves using someone else’s identity to obtain insurance policies or file claims. This can be done by stealing personal information or creating false identities.

Health Insurance Fraud

This type of fraud involves providing false information about medical conditions, treatments, or bills to receive benefits from health insurance policies.

Yes, insurance fraud is considered both a criminal and a civil offence in Australia. The severity of the penalties depends on the nature and scale of the fraud committed.

Criminal Offence

Committing insurance fraud in Australia can lead to criminal charges, which may result in fines, imprisonment, or both. The exact penalties vary based on the state or territory in which the fraud occurs.

In New South Wales, instances of insurance fraud are primarily addressed within the framework of section 192E of the Crimes Act 1900.

According to Section 192E, an individual who, through deceptive means, dishonestly acquires property owned by another, secures a financial gain, or causes a financial loss, is deemed to have committed the offence of fraud. Furthermore, an individual’s acquisition of another’s property may still be considered dishonest even if the person is willing to remunerate for the property. Proving fraud requires to be shown beyond reasonable doubt.

This section carries a maximum penalty of a 10-year imprisonment term upon criminal conviction. In certain scenarios, there may also be an obligation to reimburse the defrauded amount.

Civil Offence

In addition to facing criminal charges, individuals involved in fraudulent insurance claims may also be subject to civil liability. This means that they can be sued by the insurance company to recover the money paid out as a result of the suspected fraud. Such applications can be initiated in the Local Court of NSW for the recovery of such money.

Car Insurance Frauds Punishment Australia

False Claims

Making false claims in a car insurance policy is a serious offence. Depending on the severity and extent of the fraud, penalties may include fines, imprisonment, or both. In some cases, the offender may also face license suspension.

Staged Accidents

Staging car accidents for the purpose of insurance fraud is a criminal offence. Those involved can face significant penalties, including hefty fines and imprisonment. Additionally, they may be required to compensate the affected parties for any damages or injuries.

Car Theft and Insurance Fraud

Some individuals may attempt to profit from car theft by falsely claiming insurance for a stolen vehicle. This is a serious criminal offence that can lead to severe penalties, including substantial fines and imprisonment.

Preventing Insurance Fraud in Australia

Preventing insurance fraud requires a collaborative effort between individuals, businesses, and insurance companies. Some key preventive measures include:

Education and Awareness

Raising awareness about the consequences of insurance fraud can deter potential offenders and help individuals make informed decisions.

Enhanced Verification Processes

Insurance companies can implement stringent verification procedures to confirm the authenticity of claims and policyholders.

Investigation and Detection Techniques

Employing advanced technology and analytics can help insurers identify suspicious patterns or anomalies in claims data, allowing for timely intervention.

Legislation and Enforcement

Strict enforcement of existing laws and the introduction of new legislation can act as a deterrent for potential fraudsters.

Insurance fraud is a significant issue in Australia that has far-reaching consequences for individuals, businesses, and the insurance industry as a whole. Recognising the various forms of fraud, understanding its legal implications, and being aware of the penalties involved is crucial in combatting this problem. By implementing preventive measures and promoting a culture of integrity, we can work towards reducing the prevalence of insurance fraud in Australia.

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    Legal Advice for Fraud Charges

    If you have been charged with a fraud offence in NSW, contact our Sydney Criminal Lawyers immediately. We can provide you free legal advice for up to 15 minutes over the phone and review your criminal matter for you.

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    Insurance Fraud Australia: The Law | Lyons Law Group (47)DR Bernoussi

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    Insurance Fraud Australia: The Law | Lyons Law Group (50)Norris “Chuck” Lu

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    I cannot express my gratitude to the Lyons law team with a big special mention to Mohammad. Having spent the last few years enduring and coping with the most difficult and stressful situation of me and my family's life.I have been using Mohammad and the team at Lyons Law from day one. They guided us through each difficult process in the most professional manner with full transparency, care and compassion.Through each difficult process up to the very last moment they only delivered results that exceeded every and anything we could have expected. Every outcome was exactly as planned and in turn got amazing results.So once again I cannot recommend Mohammad and the team at Lyons law enough. So like I and my Family did, have confidence that Lyons law will always strive for and deliver the best possible outcome.

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    Insurance Fraud Australia: The Law | Lyons Law Group (2024)

    FAQs

    Where do I report insurance fraud in Australia? ›

    The Insurance Fraud Bureau of Australia (IFBA) is a working element of the Insurance Council of Australia established to help combat insurance fraud in all of its forms.

    What is the law on fraud in Australia? ›

    Section 139 of the Act defines, stipulates and prohibits fraud through deception and cases of public dishonesty. Under the act, the Court can impose penalties up to 15 years, especially in circ*mstances of aggravation. However, it also depends if the matter is handled as an indictable or summary offence.

    What are the four types of insurance fraud? ›

    Automobile Insurance Fraud. Workers' Compensation Fraud. Property, Life and Casualty Fraud (property, health, arson, life insurance fraud, and disaster relief) Disability and Healthcare Fraud.

    How long does an insurance company have to investigate a claim in Australia? ›

    Claim decision

    Once we have all relevant information and have completed all enquiries, we will decide whether to accept or deny your claim and tell you of our decision within 10 Business Days. Our decision will be made within 4 months of receiving your claim, unless paragraph 78 applies.

    How do I report a fraud case in Australia? ›

    Secondly, make reports to:
    1. your local state or territory police on 131 444 or by their website: ...
    2. any entity involved.
    3. Scamwatch if related to an email, online or telephone scam including scams from interstate or overseas.
    4. Australian Securities and Investments Commission if related to a financial/investment scam or fraud.

    How do I dispute an insurance claim in Australia? ›

    How to make a complaint
    1. Lodge a complaint with your insurer – Internal Dispute Resolution. Contact your claims manager or your insurer's customer relations team and let them know you would like to lodge a complaint. ...
    2. Lodge a dispute with AFCA – External Dispute Resolution.

    What is Australian fraud standards? ›

    The Australian Standard for Fraud and Corruption Control (AS8001) is considered a benchmark for integrity management within Australian organisations. The Standard sets out an integrated approach to bringing together integrity policies and frameworks within a holistic system.

    What is Section 11 of fraud? ›

    Section 11: Obtaining services dishonestly

    It is not possible to commit the offence by omission alone and it can be committed only where the dishonest act was done with the intent not to pay for the services as expected.

    Is fraud common in Australia? ›

    8.7% of persons (1.8 million) experienced card fraud. 2.5% of persons (514,300) experienced a scam. 1.0% of persons (199,100) experienced identity theft. 2.1% of persons (434,300) experienced online impersonation.

    How does insurance determine fraud? ›

    Insurance companies, law enforcement and special fraud investigator often use specialized data analytics techniques such as data mining, data matching, machine learning, statistics, pattern recognition, etc. to detect and recognize fraud.

    What is an example of soft insurance fraud? ›

    Soft Fraud

    Examples include exaggerating a legitimate claim or lying during the application process to get a lower rate. For example, claiming your vehicle is worth more than your insurance company's cash value of your car is a form of soft fraud.

    What is the most serious type of misrepresentation in insurance? ›

    For example, if a policyholder falsely denies prior insurance claims on their application. Fraudulent misrepresentation is the most severe form and can lead to harsh consequences, including legal repercussions.

    How do insurance claims work in Australia? ›

    After you've made your claim, the insurer must contact you within 10 business days. They may accept or reject your claim, or ask for more information. If they reject your claim, they must do this in writing. Your insurer may contact any other drivers, their insurers, and any witnesses who saw the accident.

    Can insurance companies access police reports Australia? ›

    The Code of Practice states that the NSW Police Force may only supply motor vehicle accident or crime incident reports to an insurance company or insurer, or to the agent of an insurance company or insurer, in circ*mstances where a claim has been lodged against the insurance company or insurer and the report sought ...

    What triggers an insurance investigation? ›

    Inconsistencies and delayed claims can trigger alarm bells, leading the insurance company to closely scrutinize the legitimacy of your case.

    Who oversees insurance companies in Australia? ›

    APRA regulates general insurance companies in Australia as well as life insurers, private health insurers and reinsurance companies. APRA also authorises the Australian activities of Lloyd's syndicates.

    What does the Insurance Council of Australia do? ›

    The Insurance Council of Australia (ICA) is an organisation that represents Australia's general insurance industry. The group claims that its members represent around 95% of total written premiums of private sector general insurers in the country.

    How much does insurance fraud cost in Australia? ›

    AFCA expert's advice to insurers

    According to the website of the Insurance Fraud Bureau of Australia (IFBA), insurance fraud costs more than $2 billion every year.

    What is the False Claims Act in Australia? ›

    An Australian False Claims Act9

    The FCA was enacted in 1863 to enable individuals to litigate on behalf of the government to prosecute fraudulent claims against the government.

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