Fraud Resolution Center

 

The BLD Fraud Intelligence Centre was founded in April 2009. We consider the panel necessary. The reason is simple: although the problem of fraud in the insurance industry is commonly known, it is very difficult to establish reliable mechanisms of detecting and fighting insurance fraud, not least of all because there are only limited resources within each insurance company. We can supplement those resources where claim departments’ capacities ends.

 

The problem: insurance fraud

Insurance fraud is a problem that affects the insurance industry in all segments but at different degrees. The estimates made by almost all industrial countries say that about 10 % of all claims filed in non-life insurance are fraudulent. In some segments, estimates say that even 50 % of the claims are fraudulent. The area of personal insurance is also often faced with fraudulent claims.

It ist often referred to insurance fraud as a quiet catastrophe due to the enormous damages caused thereby. The financial effects on the insurer and hence on the community of the insured are huge. Fraud against insurers is much more than a negligible phenomenon. And it is not only the "typical" fraud that insurers are faced with, but also - and in particular - with cases that are merely conspicuous without constituting fraud in the criminal sense. In these cases, however, exceptions under insurance law might apply which might release the insurer from his obligation to pay the indemnity.

The solution: BLD fraud resolution center

The main problem with fraud prevention is, first of all, to recognize conspicuous claims and to then determine facts that will stand up in court. The main investigative work has to be done before a lawsuit is filed.
 
The great importance of fighting fraud in the insurance industry has been recognized. However, implementation is often difficult in practice given the only limited resources. But the use of fraud detection software can only be one component.

 

With our BLD fraud resolution center we offer

 

  • lawyers who are highly specialized in fending off fraudulent claims out of court and in court, who have published an abundance of articles and who give presentations on a regular basis - i.e. renowned experts
  • employment of interdisciplinary fraud prevention teams
  • network of technical and other experts and private investigators as well as good contacts to government investigation agencies
  • Knowledge management through training courses, EDP-based archives, fraud meetings and much more
  • Recovery of assets in case of fraud detection

Clarification of fraud

  • Employment and guidance of private investigators
    Clear-cut instructions and concrete investigation assignments will prevent the investigations from getting out of hand and result in lower costs and produce facts that will stand up in court
  • Selection and guidance of technical experts
    Forensic insurance adjusters, experts for alarm systems, fire experts, incl. employment of fire simulation programs and debris analysis; handwriting experts; physical experts, thermodynamic experts; employment of document verification devices etc.
  • Selection and guidance of other experts
    Profitability opinions; balance sheet analyses; medical experts, expert opinions on the psychology of evidence etc.
  • Professional infobroking
  • Establishment of a countrywide whistleblower hotline number, where the lawyers commit to treat all calls secret and confidential
  • Close cooperation with the police, the DA's office and other authorities under existing laws
  • Further investigation of the case, taking into account data protection and other legal provisions

Recovery of Assets

If a fraud is uncovered, the insurer may reclaim any indemnities already paid. In order to obtain an enforcement order, it is necessary to instigate time-consuming dunning proceedings or take legal action. Normally, the injuring party will use this time to make the assets inaccessible to the insurer so that the latter cannot enforce his payment claim. 
 
It is therefore vital to secure the injuring party's assets quickly and effectively. 

 

Here, the BLD fraud resolution center becomes active by taking preliminary forced protection measures that are complex both in legal and actual terms, by, in particular, obtaining and enforcing an attachment order in summary proceedings. This way, assets can be accessed within a few days and their relocation to third parties or abroad prevented. 

Out-of-court and in-court fraud prevention

What is decisive for claims investigation and the claims settlement decision are the requirements laid down by the insurance case law with its partly modified burden of proof allocation. Here, we offer support by our highly experienced lawyers who specialize in this area.
 
The meaning of a high degree of specialization applies also, and in particular, in consideration of the specifications of the current German Insurance Contract Act. The change in law has resulted in that, on the one hand, handling cover claims has become more complicated and, on the other, that fraud prevention will become even more important. In some constellations, only bad faith will then release the insurer from his obligation to pay the indemnity.
 
If the BLD fraud resolution center is commissioned before you go to court, we will not only investigate the case but, at the same time, also provide legal examinations throughout that time. This way, cost-incurring measures will be taken only within the scope of what is relevant in legal terms. The cost of investigating and clarifying a case will be lower than for a "typical" fraud investigation. During and after completion of the case investigation, the insurer will be provided with a concrete decision memo.
 
The task of the fraud resolution center is furthermore to fend off unjustified claims before any court in Germany. Here, we will, of course, first check on a case-by-case basis whether further investigations are necessary and then carry out such investigations, if necessary.
 
We moreover provide consulting in all matters related to data protection or antitrust law within the scope of fraud prevention.

 

Knowledge management for insurers

  • We organize annual BLD fraud prevention meetings
    The topics include: Fraud resolution versus data protection. Unpublished case law on insurance fraud. Recovery assistance after a criminal offense has been uncovered. Reform of the German Insurance Contract Act and the treatment of dubious claims. Crime in the transport sector. Professional questioning techniques in case of dubious claims
  • We carry out in-house training courses that cover the entire range of fraud prevention
  • Clients can subscribe to regular BLD newsletters, where we present the most recent and yet unpublished case law and give practical advice
  • Electronic in-house archive of unpublished rulings
  • EDP-based list of selected experts

 

Presentations

Our experts at the BLD fraud resolution center not only conduct in-house training courses, but they also give numerous fraud-related external presentations at renowned hosting organizations.

 

Focus of our presentations:

 

  • Handling of dubious claims under the new German Insurance Contract Act
  • Fraud resolution in the conflict area of data protection
  • Employment of private investigators and experts
  • The insurer's technical options in the context of case clarification
  • Published and unpublished case law on fraud committed against insurers
  • Demonstration of fraudulent arson based on circumstantial evidence
  • Recovery assistance after an insurance fraud has been uncovered
  • Options and limits of offering a reward

 

 

Key Contact

 

Prof. Dr. Dirk-Carsten Günther

Leader of BLD Fraud Resolution Center

Theodor-Heuss-Ring 13-15
50668 Cologne
Tel  +49 221 944027-26
Fax +49 221 944027-927
dirk-carsten.guenther@bld.de