Insurance fraud
Also known as: Claims fraud · Premium fraud · Staged accident
Faking, causing or inflating a claim — or misrepresenting the risk at purchase — to obtain a payout or a price one is not entitled to.
At Zarv
R$5.4 billion in suspicious claims per year in Brazil; only 20% are ever proven.
Insurance fraud has two doors. At purchase, the applicant misrepresents the risk — a listed driver who is not the one driving, a garaging ZIP code that is not where the car sleeps (premium fraud). At claim, the event is faked, caused or inflated: the arranged theft, the staged collision, the padded repair bill.
In the US it is a state-law problem first. According to the NAIC, insurance fraud is a crime in 48 states, and 42 states plus the District of Columbia run insurance fraud bureaus that take referrals from insurers, whose special investigation units document and report suspected cases.
The difficulty is rarely suspicion; it is proof. Zarv's own numbers come from Brazil, where of R$5.4 billion in suspicious claims each year only 20% are proven — the rest get paid for lack of assembled evidence. Closing that gap means working both doors: behavioral signal at quote, and an objective reconstruction of the event at claim. In operations Zarv measured, claims leakage fell by up to 41%.
Frequently asked questions
Is insurance fraud a felony?
It depends on the state and the amount. Insurance fraud is a crime in nearly every state, and larger or organized schemes are commonly charged as felonies. When a scheme uses the mail or interstate wires, federal mail and wire fraud statutes can also apply.
How do I report insurance fraud?
Report it to your state insurance department or fraud bureau, or through the NAIC's Online Fraud Reporting System, which routes the report to the right state.