There are two factors in relation to travel insurance that impact claims: the low cost of taking out travel insurance; and the potential to make easy money for those who know how to work the system, often with a little help from their friends.
When fraudulent claims have been identified, we often see a distinct line connecting the insured traveller with fabricated documents produced with the assistance of family, friends, associates or corrupt officials, all of which is low risk for the insured, as there is little likelihood of any action from police and other authorities for low value fraud. On many occasions policy holders have been identified as having historical claims, across multiple insurers.
Collusion between the insured and medical providers is also common, where over-servicing is common and treatment costs are highly inflated above the actual payment, knowing the insurer will pay the amount on the invoice.
Knowledge across claim data is imperative and comes from experience, and knowing what to look for, such as a generic email address, non-existent country code phone numbers, and an eye for detail on handwriting on receipts where descriptive comments for goods differ across line items and prices, indicating additions and price alteration.
Alteration of receipts is a common form of fraud
In countries like the UAE and Egypt we have uncovered numerous occasions where receipts have been altered. It is a common problem with claims for jewellery, for instance. Often receipts are produced after a small purchase is made, and then additional items are added later to reflect a larger loss on submission of the claim.
Medical and dental work has also been subject to fraudulent claims. We have seen the insured seeking to obtain a financial benefit through the submission of fake documents, or they are seeking treatment either for a pre-existing illness or injury, or for non-elective cosmetic treatment or dental work, which has been assessed prior to travel and then claimed as emergency treatment.
One such case in Egypt focussed on a gentleman who claimed to have been travelling in a taxi, which was involved in an accident and as a result the side window of the taxi had smashed, severely cutting his head. The clinic produced a letter showing that the insured had paid US$23,000 for a 48-hour admission. If that wasn’t enough, the discovery that the surgeon’s expertise is in plastic surgery raised numerous red flags. Following an interview with the traveller, he admitted having a full-face lift and subsequently withdrew his claim.
Lebanon, Syria and Iran also continue to promote their cosmetic surgery services. Following an alleged accident in Syria, the wife of a traveller submitted a large claim for facial surgery, along with photos of bruising and alleged facial injuries. Her husband also provided photos of him standing in front of his rented Range Rover before the accident, and in support of his wife’s injuries he submitted a photo of a severely damaged vehicle that looked similar to the one they had rented.
With the assistance of our local agent we were able to obtain the original photo, which was taken in Lebanon following a military exercise, and was totally unrelated to the insured’s claim.
Potential fraud is a key reason why trusted local expertise is important
Results such as this further demonstrate the need to have a trusted resource, with local knowledge and expertise available, when required, to handle claim referrals.
The leading location for cosmetic surgery in the Middle East continues to be Iran. In 2018 the Sage Journal suggested that nine in 10 patients were women, with rhinoplasty, facial fat injection, blepharoplasty (eye lift), facelift and breast augmentation being the top five cosmetic procedures.
Back in 2013, the Guardian newspaper reported that demand had increased and there was a growing number of operations being performed by unlicensed practitioners. They highlighted that the pathology research group of the Arya Strategic Studies Centre in Tehran had issued a report stating that while there are only 157 licensed cosmetic surgeons in the capital, about 7,000 people are actually doing such work.
In 2019, the Tehran Times quoted statistics provided by the Ministry of Health, revealing that more than 500,000 foreign patients had entered Iran in 2018 for health, therapeutic, and cosmetic services.
The rise in cosmetic surgery and the ease at which people can access cosmetic travel package deals has put claim teams on notice. More than ever, it is imperative that claim information is thoroughly scrutinised by experienced claims teams.
One major fraud in Egypt used traveller information to scam £100,000 from insurers
One major fraud, which was uncovered in Egypt, centred around a small medical practice where patients were referred for treatment, often from the hotel in which they were staying. As is the case with many hotels, there are arrangements with local providers.
This fraud amounted to more than £100,000 and involved the accountant within the medical practice who was able to obtain all the personal details of the travellers at the time of treatment. Armed with that information, he would then take out travel insurance from a secondary insurer and raise an invoice for treatment. He would send that to the insurer for reimbursement into an account he had set up for the remit of funds, and fully admitted his involvement once challenged.
There have been countless fake medical records originating out of Egypt where reports and receipts were fabricated using ‘cut and paste’ headers from the internet, and on several occasions even creating medical services and clinics that do not exist.
Regardless of the type of claim or location, claims teams need to be well-versed on emerging trends in all manner of fraud, from document tampering, fake and fabricated invoices to pre-existing treatment, cosmetic surgery and over-servicing combined with excessive service fees.
Connecting the dots is the key. Inherent knowledge, intelligence, social media profiling and as always, the evidence is in the claim. You just need to know where to look and what to look for.