Insurance · General

After settling a property claim, the adjuster discovers the insured committed fraud — they inflated the value of damaged items and included items that were not actually present. What can the insurer do?

Correct answer

Seek recovery of the fraudulent payment through civil litigation and potentially criminal fraud reporting; rescind the policy for concealment/fraud under the fraud provision; reserve the right to deny future claims

  1. A Nothing — once a claim is paid, it cannot be recovered
  2. B Report to the police but take no financial action
  3. C Seek recovery of the fraudulent payment through civil litigation and potentially criminal fraud reporting; rescind the policy for concealment/fraud under the fraud provision; reserve the right to deny future claims
  4. D Only reduce future premiums

Why this is the answer

INSURANCE FRAUD RESPONSE: POLICY PROVISION: All property policies contain a fraud/concealment provision — if the insured willfully conceals material facts, misrepresents, or commits fraud, the insurer can void the entire claim and potentially the policy itself; INSURER OPTIONS: Deny the entire claim (not just the inflated portion) — most policies void the entire claim for any fraud, not just the fraudulent portion; Rescind the policy; Seek civil recovery of any amounts already paid; Report to state insurance fraud bureau AND law enforcement; ADJUSTER RESPONSIBILITY: Document all fraud indicators; consult with Special Investigations Unit (SIU); do not make coverage payments while fraud investigation is pending; preserve all evidence; PRACTICAL NOTE: Overstating claims by even modest amounts (adding a few extra items) can void the entire claim — the 'void for fraud' provision is powerful and courts generally uphold it for clear fraud.
Source: Insurance Adjuster — Claims Process, Post-Payment Fraud Discovery