Taking action after a rise: This is how they expose the fraudsters

FRAUD HUNTER: Vera Sønsthagen, head of investigations at Gjensidige, makes her living tracking insurance fraudsters. The team is constantly adopting new technology to catch people who claim more than they deserve.

“We have unfortunately seen very professional ways to manipulate documents,” says Sønsthagen. According to Finance Norway, attempted insurance fraud worth 500 million kroner was uncovered in the country last year, setting yet another bleak record. Fraudsters share few obvious traits. They may have little education or advanced degrees, criminal backgrounds or law careers, they may be women or men, young or old. What unites them is the belief that no one will notice. They feel safe from detection, Sønsthagen explains. The average attempted fraud is valued at 132 000 kroner.

The fraud hunters

In an open-plan office in central Oslo, a dozen “investigators” sit behind dual screens trying to unmask cheats.

RED ALERT: Sønsthagen shows what appears when the company’s detection system finds something wrong.

“Here someone has tried to exaggerate a completely legitimate claim,” she says, pointing to a red stop-sign icon on her monitor.

The flagged case concerns a legal-expenses policy tied to defects discovered after a home purchase. The customer has an approved limit of up to 90 000 kroner and has submitted expenses over time. The latest invoice, however, turns the alert light red.

Screenshots reveal that the amounts marked in red have been altered. The customer tried to submit a false invoice to receive more than entitled.

“They have inflated the claim by tampering with the receipt to get a higher payout,” Sønsthagen says.
“The total limit is about 90 000 kroner, and the final invoice for 2625 kroner was manipulated and therefore flagged.”

No payout at all

Although the customer did not cheat Gjensidige out of the entire sum, even a few thousand kroner have serious consequences. The insurer rejects the whole 90 000-kroner claim and demands repayment of everything already paid.

“They receive no compensation. In addition, the policy is cancelled,” Sønsthagen notes.
“We also consider filing a police report. When documents are forged, we see that as an aggravated offence.”

Fraud Detection Systems

With insurance fraud on the rise, the industry is turning to new tools. Gjensidige uses Fraud Detection Systems (FDS), software with hundreds of parameters that expose even advanced manipulation.

Automated image searches often reveal fake receipts bought online. The system also spots customers who claim that a “Louis Vuitton bag” was stolen and use web images to “prove” ownership.

Cheating for a few thousand

Receipt tampering is common among Norwegian fraudsters. Sønsthagen shows a case where a traveller claimed a damaged pair of glasses worth more than 34 000 kroner. The customer could not produce a purchase receipt but sent a bank statement instead. A check with the bank showed the transaction went to a completely different company, and the amount was greatly inflated.

“It is likely a real incident, but the amount does not match the documentation,” Sønsthagen says.
“The customer loses the right to any compensation, the policy is cancelled, and police involvement is considered.”

Former police officers on the team

Many investigators are former police officers. Finance Norway states that most fraud involves travel, contents, and motor insurance. A common tactic is to buy or upgrade cover after damage occurs.

“Fraud involving contents, cars, and travel tops the list,” says communications manager Stine Neverdal at Finance Norway.

Those who cheat in non-life insurance average 132 000 kroner in fraud, though some risk their record for only a few thousand.

The consequences can be severe, including prison.

“Insurance fraud steals from the community because insurance relies on trust. Offenders risk prosecution and, in serious cases, jail,” Neverdal warns.