Fraud management

Triglav Group introduced zero tolerance of fraud and thus clearly expressed its commitment to fair, responsible and legitimate business operations. The fraud management policy is based on prevention, detection and investigation of fraud. These three pillars of anti-fraud defence are integrated in all business processes in our insurance group and enable fraud management across the entire range of its operations.

Fraud is a deliberate act of deception committed to obtain an illegitimate benefit from an insurance company. It can take many forms, including insurance fraud (filing false claims, exaggerating damages, etc.), forging of documents, corruption and the unlawful appropriation of assets.

The most common form of deception in the insurance business, insurance fraud is when an individual engages in the following conduct with the aim of receiving compensation from an insurer:

• deliberately damages or destroys objects;
• enters into an insurance contract after a loss event has occurred;
• enters into an insurance contract using inaccurate or false information;
• presents false or forged documents;
• presents a false picture of or invents the circumstances surrounding a loss event.

By managing insurance fraud and other types of fraud we will lower our costs and the costs of our clients. Help us be more effective in preventing, detecting and investigating fraud by telling us about attempted or committed cases of fraud.

Examples of insurance fraud

False report of damage on the vehicle: The customer reported damage to the vehicle that was allegedly caused in a traffic accident. With the help of field inquiries and the analysis of documents and photos, our team found out that the damage was already caused before the vehicle was insured.

False theft report: A customer reported the theft of valuable jewelry that was supposed to be insured. Through investigation, our team determined that the customer sold the jewelry before reporting the theft and attempted to obtain an unjustified payment.

Inflating the value of the damage: The customer reported damage on the property due to flooding and inflated the value of the damage. In the investigation, it was found that the invoices provided were fictitious, and many technical items were brought to the flooded basements, which were not flooded at all.

Advanced computer system for detecting and investigating all types of criminal offences

In order to effectively combat insurance fraud and any other crime Zavarovalnica Triglav, d.d., is faced with, we have implemented an advanced computer solution. It helps us prevent, investigate and research fraud. Software elements (such as i2) are standard products in global industrial sectors used by more than 4,500 organisations worldwide (insurance companies, banks, intelligence services, police, army, authorities in charge of money laundering prevention etc.).

Fraud awareness-raising campaign

Insurance fraud causes damage not only to the insurance company, but also to the policyholders since it raises premiums. Therefore, we decided to inform Triglav’s clients about this problem and show them how they can help us fight insurance fraud.

The aim of the campaign is to draw attention to the harmful effects of insurance fraud and encourage Triglav’s policyholders and employees to help prevent them for the common good. Insurance fraud is a criminal offence.

Objectives of the campaign:

• inform people about the problem of fraud,
• present the negative consequences of insurance fraud,
• show how Zavarovalnica Triglav, d.d., is successful in insurance fraud detection.

Most fraud attempts combine vivid imagination and quirky plans to commit fraud, sometimes involving employees in insurance companies. Loss assessors are also faced with imaginative stories, such as presented in the video below with Severina.