Insurance claim investigations, fraud & dishonesty allegations

An allegation of fraud is materially different from an ordinary coverage dispute. It can affect the claim, the policy and future insurance, and the insurer may be examining recordings, documents, device data, financial records or other evidence for inconsistencies.

If the insurer is using words such as fraud, dishonest, fabricated, staged or deliberately misleading, treat the issue as high stakes. Get the allegation clear and avoid trying to explain every inconsistency off the cuff.

Get the allegation in writing

Ask what conduct is said to be dishonest, what evidence supports that conclusion and what consequence the insurer says follows. Distinguish an allegation that the insured event never happened from an allegation that part of the value was exaggerated or that evidence was fabricated.

Preserve the original evidence

• Keep original photographs and files rather than editing or recreating them.
• Retain messages, receipts, call records and documents relevant to the chronology.
• Do not delete material because it appears unhelpful; context can matter.
• Record what you previously told the insurer and correct genuine mistakes clearly.

Why the allegation matters legally

Section 12 of the Insurance Act 2015 sets out statutory remedies where an insured makes a fraudulent claim. These can include refusal of the claim, recovery of sums already paid in respect of it and, in some circumstances, termination of the contract from the time of the fraudulent act.

The Act does not itself define every situation that amounts to fraud; that remains a serious legal question. Do not treat a minor mistake or discrepancy as automatically proving fraud.

Do not confuse claim fraud with misrepresentation at sale

An allegation that information was wrong when the policy was bought or renewed is usually analysed through the consumer misrepresentation regime. An allegation that the claim itself is fraudulent is a different issue. The insurer should be clear which case it is making.

Answer evidence, not insinuation

Where the insurer identifies a concrete discrepancy, deal with that discrepancy. If dates differ, explain why and provide records. If a document is said to be unreliable, establish its source. If usage data or location evidence is relied on, ask exactly what it shows and what inference the insurer draws from it.

A broad assertion that you are “concerned about how the claim has been handled” is unlikely to resolve a specific fraud allegation.

When specialist advice is sensible

Consider specialist legal advice before making a detailed response if the allegation is serious, the value is high, the insurer is threatening policy termination or recovery of money, or there is any possibility of parallel civil or criminal consequences.

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