Insurance Fraud

Insurance Fraud: Following the adoption of the French law of July 13, 1930, the doctrine had a habit of mind that the insurance contract is a contract in good faith, not only must it have been concluded according to this frame of mind but it must continue all the time of the execution of this Agreement will. Good faith got on at that time mostly from the insurance required to declare all circumstances that allow the insurer to get an accurate view of the risk it intends to take care of later texts including law Joint development of the Consumer Code and the Act specifically yal’assurance French 31 December 1989 may have can be made a Guelder this implied obligation of the insured pence as attention focused on the actions of the Insurance latter is considered in a situation of superiority to the insured because it has information element which it does not benefit. If this concern is generous and happy, it does not encourage mésistimer the ability of imagination of some policyholders whose integrity is questionable. In other words, all ill-gotten gains and attempt to save not be excluded. Yet it should not give these terms more broadly than that prevailing in the insurance say that the concept of fraud is constantly in search of its own limitations. Basically the first step is to define “Insurance Fraud” for this work. “The insurance fraud” within the meaning of this text will be “a deliberate act to take advantage of an insurance contract. This act requires the insurance bad faith. It does therefore not fraud if the insured to act by mistake or in the legitimate belief that he committed no impropriety. ” It is interesting to note that definition of the civil code. (This 2563 s. 2).
The insurance fraud is a vague term, or at least generically to describe the practices of certain policyholders for obtaining the completion of the presentation of the insurance they are not entitled. The concept of fraud encompasses several attitudes on the part of the insured. Two attitudes can be distinguished. Or the insured creates a disaster so artificial and voluntary. In many fraud consists of misrepresentation in the valuation of the loss. In other words, the insured often organizes a scam. Indeed the latter defined in section 313-1 of the French Criminal Code and Article 405 of the former Criminal Code could still be explained as the offense of violating the property of others in obtaining it he who possesses the delivery of property by deception characterized.
If any insurance fraud is not a scam, any fraud is a fraud. Without statistical rigor, it is also possible to consider that the misrepresentation of the actual value of a property will be less likely to often be described as fraud while the declaration of a disaster that seems to be fictitious qualifications.
Like other economic sectors, the insurance fraud if it is old, not an evil being eradicated, far from it. Despite the qualification and penalties incurred by the insured, they are it seems increasingly likely to be fraudulent.
And the Insurance Code provides no definition of fraud that is only mentioned in two or three articles essentially Articles L113-8 L121-3, L121-4, Force is to help the general theory fraud to locate the insurance fraud and outline its originality.
The Civil Code does not define himself fraud he occasionally cites. Fortunately, remarkable doctrinal studies have yielded a general theory.
There are two aspects to the legal notion of fraud, the first relates to the definition of acts may characterize a fraud, the second the punishment of fraud.
In its general aspects, fraud always intended either to exclude or to claim unfair application of a rule of law. It is a disturbance and a violation of law, that it can tolerate. This concept refers mainly fraud statute: the concealment of income to escape taxation, marriage fraud for claiming the French nationality for example. This seems not to understand the insurance fraud that takes place within the framework of a contract.
But in reality, it is still there in violation of a rule is mandatory, not an act but a contractual rule.
In entant able to get the compensation to which he is not entitled, by believing in imaginary or caused an accident, the insured violated. Don Rule contractual, binding upon the parties and commits fraud.
But it does not breach the contract for there to be fraud. The breach of contract by the legal rule is the object of fraud is the goal pursued in the case of attempted fraud or result if fraud was implemented.
The fraud involves two more elements that allow the characterization.
It should be a part of the maneuvers performed by the insured (or accomplices) to circumvent the rule and to conceal the truth (false statements, in series of camouflage in an arson accident etc ….) It the material element of fraud.
And above all we must fraudulent intent, or the subject’s will to evade or violate the rule of law.
But fraud is a sanction mechanism. This is to prevent the operation succeeds or correct the effects of fraud when it was successful. That is to say in the insurance fraud when compensation has been paid. The legal and moral prohibit bad faith and would save not tolerate a law be evaded or acquired by dishonest. In addition it is desirable to protect the victim of fraud here is the insurance company. And originality of the theory of fraud is that it can punish the maneuver, where all the sanctions have failed.
Fraud acts as a corrective mechanism of that illegality expressed by the adage, “omnia-fraus corrumpit” what received as a principle of law. “Fraud corrupts everything” means any act committed by fraud must be annulled or declared unenforceable, even if there is no provision that penalty.
This theory obviously applies to insurance fraud. She did every time an application receives indirect subsidiary, since the insurance law, contract law and organizing themselves in acts of fraud penalties are invalidity or revocation as appropriate.
After explaining the concept of insurance fraud, and his relationship with the offense of fraud it is important to consider that notion could be the latter? What is its impact in the insurance field? And what is its variety in the different branches of insurance? That is what we will try to demonstrate through the following titles:
>> The criminal offense of fraud (introductory chapter)
>> Scope and search for fraud in the insurance sector (Chapter I)
>> The variety of scams in the various branches of insurance (chapter II)
REFERENCES:
1) The French-language works:
* D. SORO “Fraud in Health Insurance: Diagnosis and Therapy”, Institut National Polytechnique, Yamoussoukro (Ivory Coast) – Engineering Diploma of Higher Studies in Insurance, 2003, p: 83
* Caron L. “The insurance fraud.” Paper presented at the economics department to obtain the degree of Master of Science (M.Se.) in Economics, University of Montréal.1996. p: 50
* Publication of the Faculty of Law and Social Sciences at the University of Poitiers “The fight against insurance fraud.” Proceedings of the Symposium organized at Niort 28 and 29 June 1990 by the Faculty of Law and Social Sciences Poitiers, The ISEUP and ALFA Insurance Française.1991. p: 201
* J. BIGOT “deals with insurance law,” Tom3, the insurance contract. L.G.D.J. 2003, point Bookshop, Beirut, p: 1365
* R. VOUIN and M. Rassat L, “Special Criminal Law, 6th ed, 1988. p: 1037
* P PICARD “the insurance fraud some elements of analysis” might Jul. September 1996. p: 276
* R AND MERLE A. Vitu Treatise on Criminal Law II “1989. p: 842
* G. and J. FRAY Barbancey; the “insurance fraud” Gaz.Pal, October 3, 1978; JGATZI, “the insurance fraud: state of play”, Small Posters, 24 June 1996,
2) Articles:
* Cass. 1civ June 4, 1996 Contracts Bellaloum cons Allianz Life and other Bull civ. No. 233.
* Crime June 14, 1977 D 1978. 127 note ROBERT JM.
* JM ROBERT, note under Crime June 14, 1977 No. 127.
* Crime May 27, 1959, Bull No. 282 Crime Add Crime Science Rev. 1979 No. 539, observed J. Larquier and 1985 No. 63 observed A. Vitu
* May 3, 1974 View Crime Crime bull No. 157 May 1979 crime bull No. 175.
* Crime October 10, 1957 D 1958 p 386 notes 28 February 1967 Bull MEURISSE crime.
3) Websites:
Www.assrance-info / life insurance / life insurance fraud.
Www.ibc.ca / en / Insurance Crime / staff-in-jury fraud.
Www. On-line memory. Com.
SUMMARY:
INTRODUCTION
PRELIMINARY CHAPTER: THE VIOLATION OF CRIMINAL FRAUD
1 § The elements of the crime of fraud
§ 2 The judicial delimitation of the contours of the scam
3 § Sanctions
CHAPTER I: SCOPE AND RESEARCH FRAUD IN THE FIELD OF INSURANCE
Section 1: Identification and quantification of fraud
1 § The measurement difficulties
I-proof of insurance fraud
A-The purpose of the evidence
B-the burden of proof
C-How to prove fraud?
II-the difficulties of police investigation
III Examples of difficulties
2 § The assessment of insurers
Section 2: The methods of investigation and control
1 § The control organizations
ALFA-A agency
B-linkage group (Glafira).
2 § means of action
3 § The effectiveness of the fight
A-prevention has several forms
B-sanctions are becoming more varied
CHAPTER II: THE VARIETY OF SCAMS IN THE VARIOUS BRANCHES OF INSURANCE
Section 1: The fraud and Casualty Insurance
1 § The maritime insurance fraud
2 § The insurance fraud theft
3 § The insurance fraud fire
4 § Insurance fraud material accidents
Section 2: The fraud and insurance people
1 § The insurance fraud on life
I-Definition of Life Insurance
II-The fraud insurance in case of life
III-The fraud insurance for death
2 § The insurance fraud accident and illness
I-Personal accident insurance
1 – Definition
2-what is the injury?
3-L’escroquerie for injury
II health insurance
1-Definition of Health Insurance
2-L’escroquerie health insurance
CONCLUSION.
APPENDICES
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- J. BIGOT “Trafficking of insurance law” volumes 3, the insurance contract. LGDJ 2003 p: 1027.
Caron L. “The insurance fraud.” Paper presented at the economics department to obtain the degree of Master of Science (M.Se.) in Economics, University of Montreal .1996. p: 6
- Cass. 1civ June 4, 1996 Contracts Bellaloum cons Allianz Life and other Bull civ. p: 233.
- P-PICARD “the insurance fraud some elements of analysis” might Jul. September 1996 p: 27 – 171 and S
Also in the Moroccan legislature article Dahir No. 1-02-238 41du of 25 rejeb 1423 promulgating Law No. 17-99 concerning the insurance code. (RB, 7 November 2002) of the Insurance Code as: “Where an insurance contract has been agreed for a sum greater than the value of the insured, if there was fraud or fraud of a party the other party may demand the nullity and claim further damages. ”
Mr Jean-Beauchard “Suppression of insurance fraud” 1991 in the fight against insurance fraud, colloquium at Niort on 28/29 June 1990 by the Faculty of Law and Social Sciences at Poitiers the ISEUP and ALFA p: 61 ff
- J. Beauchard. “The repression of insurance fraud aspects of civil law” 1991 in the fight against insurance fraud, colloquium at Niort on 28/29 June 1990 by the Faculty of Law and Social Sciences at Poitiers ISEUP ALFA and p: 63.
- J. Beauchard. “The repression of insurance fraud aspects of civil law” 1991 in the fight against insurance fraud, colloquium at Niort on 28/29 June 1990 by the Faculty of Law and Social Sciences at Poitiers ISEUP ALFA and p: 64.