Insurance fraud

Submitted: Tuesday, Oct 22, 2013 at 13:16
ThreadID: 104821 Views:3006 Replies:16 FollowUps:21
This Thread has been Archived
In Broken Hill local news paper a local police officer is being charged with making a false claim.

He made a claim saying he had hit a roo on menindee road but he was out the back of Broken Hill in a dry creek bed when he did the damage.

some one contacted the insurance company and told them what happened.

his claim $1700 and car hire are going to have to be payed back if found guilty

ok so I thought you were covered off road or do you need to have a special policy

what insurance options does a person wanting to go off road

Back Expand Un-Read 0 Moderator

Reply By: Krooznalong - Tuesday, Oct 22, 2013 at 14:05

Tuesday, Oct 22, 2013 at 14:05
Just guessing but probably not allowed to take hire car off-road. Thus he (allegedly) changed location to on-road. Thus claim was false. And thus he is in deep poo.
AnswerID: 520176

Follow Up By: garrycol - Tuesday, Oct 22, 2013 at 14:27

Tuesday, Oct 22, 2013 at 14:27
who said he was driving a hire car - the OP implied he was given a hire car after the incident and will have to pay its cost back.
1
FollowupID: 800603

Follow Up By: Krooznalong - Tuesday, Oct 22, 2013 at 14:52

Tuesday, Oct 22, 2013 at 14:52
My bad there garrycol - misread it.
1
FollowupID: 800608

Follow Up By: garrycol - Tuesday, Oct 22, 2013 at 16:09

Tuesday, Oct 22, 2013 at 16:09
No worries - just wondering though why not claim the accident where it happened - maybe it was his cop car and was not supposed to be where he was.
0
FollowupID: 800616

Reply By: allein m - Tuesday, Oct 22, 2013 at 14:42

Tuesday, Oct 22, 2013 at 14:42
the claim was

$1700 damage to his 4x4 which is why I asked about insurance for off road driving

the damage was done in a dry river bed not on the main road as he stated on his form

he also got money for a hire car while his was being repaired

I hope that explains it better
AnswerID: 520179

Follow Up By: allein m - Tuesday, Oct 22, 2013 at 14:46

Tuesday, Oct 22, 2013 at 14:46
ok here is the charge

dishonestly otabtaining financial advantage by deception

he pleaded not guilty and new court December 17
0
FollowupID: 800606

Reply By: yarda - Tuesday, Oct 22, 2013 at 14:53

Tuesday, Oct 22, 2013 at 14:53
It all depends on your policy, the good ones cover you as long as you are on a marked road or track. Up an unofficial track, creek bed etc and you are usually not covered.

My policy covers me "doing anything the vehicle is designed to do" on a marked road or track.

It's the old story, you get what you pay for and buyer beware. Insurance is all about risk management.
AnswerID: 520180

Reply By: Krooznalong - Tuesday, Oct 22, 2013 at 15:00

Tuesday, Oct 22, 2013 at 15:00
OK - I'll try again.
Perhaps his policy didn't provide cover for damage in the creek bed so he changed the location to one where cover would be available. I understand that policies vary in the level of cover allowed for "off-road", depending in what their definition of that term is.

So allein you'd need to check what a particular policy actually covers you for. No special policy required - just an appropriate one.
AnswerID: 520181

Reply By: get outmore - Tuesday, Oct 22, 2013 at 15:17

Tuesday, Oct 22, 2013 at 15:17
to see if your covered offroad just read your PDS. there may be more than 1 clause relating to if you are .
for instance im insured with the RAC and im covered
1) anywhere within australlia

- so thats pretty simple im covered offroad off track off whatever.

however keep reading and im not covered
- if im not legally allowed to be there
- if im engaging in racing or traillling
- if the damage is deliberate
AnswerID: 520183

Reply By: The Landy - Tuesday, Oct 22, 2013 at 15:24

Tuesday, Oct 22, 2013 at 15:24
For insurance the key is to check the Product Disclosure Statement (PDS) that accompanies the policy, preferably before you purchase it.

Comprehensive Insurance is to cover you for accidental loss and damage, full stop. It is up to the insurance company to declare what they don’t cover or if they want to limit liability in anyway.

If they don’t intend to cover you for creek crossings or driving across country on an ungazetted road, or on no road at all, they need to tell you that. If they don’t then you are covered if you have an accident.

You can safely work on the basis that if it is’t specifically excluded under the policy than it is included. It isn’t a grey area, it is black and white.
AnswerID: 520185

Follow Up By: Member - Chris_K - Tuesday, Oct 22, 2013 at 15:57

Tuesday, Oct 22, 2013 at 15:57
Hi Landy

Not sure I would agree about the "black and white" bit - every insurance company will try their best to get out of a claim if they can - or reduce their liability. "Assessors" and "Loss Adjustors" are really "risk minimisers" for insurance companies, and should be treated in the same way. Case in point - guy drives across a creek on the way to Cape York and drowns the vehicle (Range Rover actually). No snorkel. Insurance company refuses to pay initially due to the "Duty of care" or as mentioned before "deliberate damage". Not sure of the outcome there as he was waiting to go home on the next plane. But it will be a bleep fight.

I think we can all safely assume that unless we are doing the right thing with the right equipment, insurance companies will question you...hence the "grey". If in doubt - you need to ask the insurance company for a written confirmation (via email) that you are covered for where you want to go...get the consultants name and contact number and make some notes in your diary about your discussion on the day.

That's my rant anyway! :)
1
FollowupID: 800614

Follow Up By: allein m - Tuesday, Oct 22, 2013 at 16:26

Tuesday, Oct 22, 2013 at 16:26
Yes i see what you mean it is in the interpretation

I had a situation on the road along the railway line just out of town part of the road gave way into a old dam as i was driving past I rang RAA no cover pay for tow your self

next day we went back to the road took a number of pictures and explained what happened and emailed all that to RAA manager after looking at the information he said I was covered

so even if you are not covered in some circumstances it is best to ask some one a little higher up the chain of command and ask

thanks for your replys
0
FollowupID: 800619

Follow Up By: The Landy - Tuesday, Oct 22, 2013 at 16:58

Tuesday, Oct 22, 2013 at 16:58
Hi Chris

For sure, insurance companies have the right to question any claim, but what is black and white is the policy exclusions, and if it isn’t excluded, it is included by default.

If poor judgement and duty of care was worded into a policy insurance companies would go out of business tomorrow, nobody would take one out if it was that easy for them to refuse a claim.

The instance you cite may indicate the driver had poor judgement and that lead to an accidental “drowning” of the vehicle, but that doesn’t mean the insurance company can reject the claim on those grounds.

Unless the policy prohibits the crossing of creeks, and I would be surprised to find a comprehensive policy that does, then I can’t see any reason this person is not covered. Comprehensive insurance is specifically to cover accidental damage.

The reason there is a clear and concise PDS accompanying an insurance policy is so it sets out in full detail the obligations and responsibilities of all parties. Insurance companies don’t get to pick and choose what they may or may not pay out on after the event. Unless of course it potentially falls into one of the following categories, and these are the most common reasons insurance companies do not pay out.

Non disclosure – You didn’t disclose all the information required prior to buying policy

Exclusion clauses – The policy doesn’t cover the loss (policy must state this)

Fraud – An obvious one

Policy cancelled – Premium not paid etc, or the insurer cancelled policy under advice to you

And a word on exclusion clauses, the insurer must demonstrate that the exclusion clause is relevant to the claim...
1
FollowupID: 800624

Follow Up By: Member - Chris_K - Tuesday, Oct 22, 2013 at 17:36

Tuesday, Oct 22, 2013 at 17:36
Perhaps it my significant mistrust of insurance companies that is the real issue here! :) We haven't had the misfortune to make too many claims - but I have heard horror stories. FYI - I also hate banks...with a passion.

Chris
1
FollowupID: 800629

Follow Up By: allein m - Tuesday, Oct 22, 2013 at 17:52

Tuesday, Oct 22, 2013 at 17:52
Perhaps it my significant mistrust of insurance companies that is the real issue here! :)
that is a problem that should be addressed they hold the power of a yes or no for any claim


0
FollowupID: 800632

Reply By: allein m - Tuesday, Oct 22, 2013 at 15:26

Tuesday, Oct 22, 2013 at 15:26
So it pays to ask questions and if you are not happy with what they say find one that you are happy with

and read the fine print

thank you
AnswerID: 520186

Reply By: allein m - Tuesday, Oct 22, 2013 at 15:28

Tuesday, Oct 22, 2013 at 15:28
thanks landy I hope all is well at your place cheers mate.
AnswerID: 520188

Reply By: Neil & Pauline - Tuesday, Oct 22, 2013 at 15:57

Tuesday, Oct 22, 2013 at 15:57
I have taken out one of the cheap policies but many exclusions. Standard policy is only for sealed roads, I added that back in for an increase of premium. The rest suits me just fine for the time being. If I had toatal cover as I had previously then the premium will be much the same. Basically you get what you pay for and no more.

Neil

AnswerID: 520195

Reply By: get outmore - Tuesday, Oct 22, 2013 at 17:20

Tuesday, Oct 22, 2013 at 17:20
remember - I see many posts on how good an insurance policy is mostly referring to price

you (including me) only really know how good your policy is when you claim - not when you pay your premiums
AnswerID: 520200

Reply By: Dennis Ellery - Tuesday, Oct 22, 2013 at 17:22

Tuesday, Oct 22, 2013 at 17:22
I have a standard QBE motor vehicle policy.
On a sandy beach, a long way from a track, I was crossing a rocky outcrop and slid into a hole and dented the side of the 4WD.
QBE paid out without a quibble – stated I was covered anywhere in Australia.
AnswerID: 520201

Follow Up By: allein m - Tuesday, Oct 22, 2013 at 17:54

Tuesday, Oct 22, 2013 at 17:54
that is good too hear thank you
0
FollowupID: 800633

Follow Up By: Kris and Kev - Tuesday, Oct 22, 2013 at 18:42

Tuesday, Oct 22, 2013 at 18:42
I can also give QBE a tick. We have QBE cover on our camper trailer and on a recent trip in WA we sustained major suspension damage and QBE covered the full repairs immediately and without hesitation. Kevin
1
FollowupID: 800637

Follow Up By: allein m - Tuesday, Oct 22, 2013 at 18:56

Tuesday, Oct 22, 2013 at 18:56
it is comforting to know there are some good insurance company's out there

thank you
0
FollowupID: 800640

Reply By: Rob K (VIC) - Wednesday, Oct 23, 2013 at 08:39

Wednesday, Oct 23, 2013 at 08:39
Hi Allein m,

I have insurance cover for my 4WD and C/T through a broker in Adelaide. It's not the cheapest by any stretch of the imagination but it has the wording "no geographical limits within Australia". This provides me with a lot of confidence that I will not have to have a fight with the insurance company if something goes wrong regardless of where we are travelling (beach, cross country, unmarked tracks etc.).

As others have said, it's all in the wording, interpretation and attitude of the assessor. Hopefully, if I find the need to make a claim in the future, it will be hassle free.

Cheers

Rob K
AnswerID: 520237

Reply By: Lyn W3 - Wednesday, Oct 23, 2013 at 12:07

Wednesday, Oct 23, 2013 at 12:07
Insurance Companies are in the business to make a profit for their shareholders by paying out less than they take in.

After paying insurance for 20 years and never making a claim I came to the realization that I was on the loosing end of the equation.

When we buy a vehicle now we pay cash and invest a similar amount (value of the new vehicle) in an interest bearing deposit just in case something happens. In the 15 years we have been doing this we haven't touched the investment which is steadily growing.

AnswerID: 520241

Follow Up By: garrycol - Wednesday, Oct 23, 2013 at 12:37

Wednesday, Oct 23, 2013 at 12:37
But do you also have the funds to cover that $1m Bughatti Veyron that you might run into one day.
1
FollowupID: 800660

Follow Up By: Bazooka - Wednesday, Oct 23, 2013 at 12:44

Wednesday, Oct 23, 2013 at 12:44
Yes it's an interesting equation that one and with rising premiums for some insurance always worth some consideration. Makes new insurance initially quite expensive if you ever decide to take it on though.

Presumably you have TPP? I've just recently dropped comprehensive because the cost/value ratio on my 15 year old Jack is now basically unviable but I do carry TPP++. That means essentially I am not covered for self-inflicted damage, nor theft of contents. But I am covered to a limited amount if hit by an uninsured motorist and for a larger amount for fire damage and if my vehicle is stolen and/or damaged.

Horses for courses.
1
FollowupID: 800661

Follow Up By: The Landy - Wednesday, Oct 23, 2013 at 13:10

Wednesday, Oct 23, 2013 at 13:10
Now here is the thing about car insurance, the best outcome is that you never claim on your policy, after all you are only claiming if something goes wrong, right?

Self-insuring is always an option, but the problem is you will never be able to put enough away to cover your liability in the event of a major accident. And it may not involve another vehicle, it might be property damage, it could be anything. Insurance companies get an enormous spread of risk because of the large client base and the number of people they insure, something you don’t get when self-insuring.

Interestingly, not even insurance companies will bear all the risk that they cover, they in turn also cover a lot of the risk they are exposed to by entering into re-insurance agreements from re-insurers.

Why?

Simply, to spread the risk...
1
FollowupID: 800663

Reply By: allein m - Wednesday, Oct 23, 2013 at 13:24

Wednesday, Oct 23, 2013 at 13:24
Lyn W3 I can see where you are coming from but a minor dent can cost a lot of money

we had a accident when a young kid on a motor bike hit our car on a dirt track out of town $3000 replace wing and paint, the car is not even worth that.

but dad owned a business here and town and paid out to get it fixed and even gave up a spare work ute while our car was being fixed


our car at present is covered 3rd party only when we upgrade to a 4x4 we will fully insure that but even today looking at some of the on line cover I know I am going to have to do some leg work

progressive on line $600 for a hilux and only $2000 worth of extras covered

one company said no I put down and cost of roo bar winch and lights I was over there limit for extra items


so I will be doing a lot of research and find the right one for us

I know of a lot of people who have paid insurance all there life and got nothing back

but for the average man in the street it is the only safe way to drive if you hit some one or damage property you could loose your home or other assets if you cannot pay

some people on the other had do not care and drive with no registration or insurance and expect others to pay for damages we had one here in Broken Hill has not had a license for years but kept driving only reason why he is not in jail is he had end stage kidney failure.
AnswerID: 520243

Follow Up By: allein m - Wednesday, Oct 23, 2013 at 13:26

Wednesday, Oct 23, 2013 at 13:26
the kid who hit us it was his dad who owned the business.
0
FollowupID: 800664

Follow Up By: Bazooka - Wednesday, Oct 23, 2013 at 17:14

Wednesday, Oct 23, 2013 at 17:14
Assuming your vehicle in legally registered, CTPI covers personal injury to third parties - passengers and/or others you may injure. "Property" damage is where comprehensive, TPP and similar insurances come into play. TPP should probably also be compulsory.
1
FollowupID: 800675

Follow Up By: Bazooka - Wednesday, Oct 23, 2013 at 17:16

Wednesday, Oct 23, 2013 at 17:16
is legally registered
1
FollowupID: 800676

Reply By: howesy - Friday, Oct 25, 2013 at 11:52

Friday, Oct 25, 2013 at 11:52
Yes technically he has broken the law in falsely stating how the damage was caused but at the end of the day he still damaged it. Its the insurance company's bulldust clauses to get out of paying up that encourage this sort of behaviour,, if it was me the next thing I would hit would be the one who goes out of their way to tell the insurance company I hope he/she's next claim of their own is denied so I can publically ridicule and laugh at them,,, it's called Karma
AnswerID: 520332

Follow Up By: The Landy - Friday, Oct 25, 2013 at 16:01

Friday, Oct 25, 2013 at 16:01
Condoning a Police Officer's actions in making a false declaration is a slippery slope for society to be on, let’s not put them above the law...


0
FollowupID: 800776

Follow Up By: howesy - Saturday, Oct 26, 2013 at 00:22

Saturday, Oct 26, 2013 at 00:22
Who said I condoned it? I said insurance companies policies encourage that type of behaviour. People who do that sort of thing get caught by their own stupidity eventually. People in all walks of life break the law including Police and Magistrates, gaols are full of them.
0
FollowupID: 800793

Follow Up By: Bazooka - Saturday, Oct 26, 2013 at 22:45

Saturday, Oct 26, 2013 at 22:45
Anyone who claims something they're not entitled to, legally or ethically but particularly the former, is committing theft, whether it involves insurance, govt payments, etc. Apart from the obvious dishonesty involved it doesn't just cost the company it costs us all. We don't know the "dobber's" motive but if indeed his information is accurate then his action should be applauded not derided. Surely you'd want someone who saw thieves making off with your caravan spare tyre to report them to police? Fraud and theft deserve to be exposed wherever they occur.
0
FollowupID: 800847

Reply By: allein m - Friday, Oct 25, 2013 at 14:44

Friday, Oct 25, 2013 at 14:44
it's called Karma

yes there is the question why did the person ring up the insurance company

that in its self would be a interesting story

but sadly we will never find out

I think that there is a culture of making less than credible claims

six months ago a massive mobil crane went up in smoke I am not sure on insurance claims but


I know from reading the paper and people in town that this company had lost a lot of major contracts and were finding it hard to make ends meet

A lot of people are thinking that is one way to solve financial problems but proving it is fraud that is another problem,

I have no idea what percentage of claims are fraudulent but I am sure the insurance company's write that into the cost of every insurance out there .
AnswerID: 520337

Sponsored Links

Popular Products (13)