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Understanding insurance fraud markers
An insurance fraud marker (False Insurance Claim under CIFAS categories) is filed when an insurer believes a claim involved material falsehood, exaggeration, or false supporting information. Around 420 cases are recorded annually, but this category is growing at 60% year-on-year.
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Types of insurance fraud allegations
- Exaggerated claim, the claim was genuine but the value was overstated
- Fabricated claim, the claimed event did not actually occur
- Non-disclosure, relevant information was withheld during the application
- Staged incident, the event was deliberately arranged
- False supporting documents, receipts, valuations, or reports were falsified
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The exaggeration vs fabrication distinction
There is a significant legal difference between exaggerating a genuine claim and fabricating a false one. Many insurance fraud markers are filed for alleged exaggeration, where the underlying event was real but the insurer believes the claimed amount was inflated. This distinction matters because the evidence required to prove fabrication is much higher than for exaggeration.
If your claim was an honest estimate and the insurer has recharacterised it as exaggeration, the complaint should challenge this characterisation. Honest estimations are not fraud.
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How to challenge an insurance fraud marker
The distinction between honest estimation and deliberate exaggeration is legally significant. Where your claim was an honest estimate and the insurer has recharacterised it as exaggeration, the complaint should challenge this characterisation directly. Honest estimations are not fraud. The insurer must demonstrate that you knew the estimate was inflated and included it with the intent to mislead.
Where the underlying event was genuine and the dispute is about the value claimed rather than whether the event occurred, the challenge has a different character than a fabricated claim case. Address the evidence question directly: what specific evidence does the insurer hold that establishes dishonest intent rather than honest estimation?
Evidence threshold
The insurer must hold clear, rigorous evidence of dishonest intent, not merely a belief that the claimed amount was higher than expected. That is the evidential gap most insurance fraud marker challenges target.