Monday, May 23, 2022

Who’s fooling who?

A lot of people will probably read this article and not feel affected by it or, even worse, forget about it. The same way that they have ignored any previous articles which tend to warn people about very serious issues such as HIV, drugs, road accidents, so forth and so on. Be that as it may, it has not deterred this writer from working on this article. The incentive for producing this article goes beyond the “pat on the back” or any other sort of reward. Rather, it is the satisfaction that comes with feeling that you are in a better place (ethically) and you have about you a sense of “you don’t know what I know about you”. So much that you are confident enough to give a warning to others by looking them in the eye and asking “who’s fooling who?”.

Besides, it would sort of be fulfilling to finally get an answer to this question that most of us will remember from that hit song. Granted, that song was sung in a context totally unrelated to that of this article, which is, by the way, about FRAUD. However, the underlying objective of that song is the same as of this article. Now that’s what you call a good song!

This article is not just about any fraud; it is about insurance fraud. Fraud has many definitions, depending on what you read and, for purposes of this article, it is as follows:

“Fraud is the unlawful, intentional making of a misrepresentation which causes actual prejudice to another or holds potential prejudice to another.”

Now that you know what fraud is, think carefully: does this sound like any scenario you are aware of or have been a part of?

The following is an attempt to put the above definition in the context of insurance fraud. Have you ever obtained an insurance policy, which you otherwise would not have qualified for had you not adjusted some pre-requisite documents e.g. pay slip, medical report? Or have you ever put in a false claim with your insurer e.g. by submitting a false death certificate. Probably, some readers would by now have stopped reading this article, more out of guilt than anything else. For those that are curious or even seeking emancipation which the truth always provides, read on.

Perhaps, the aforesaid paints too simple a picture. It has become public knowledge that there tends to be some very unscrupulous intermediaries who in pursuit of commission encourage or even abet clients to adjust their documents so that they qualify to get insurance. Sure, in some cases it can beat the system (but not for long) but in most it gets discovered. Your guess is as good as the writer’s as to what happens next. Yes! The intermediary walks away with commission (will be recovered though, but that is another story) and the client remains with NO INSURANCE! So, who’s fooling who?

Most intermediaries are very honest and hard working; it is just a few who tarnish the image of an otherwise noble profession and clean industry. So the above example was not meant to blemish anyone’s character just to stress a point, by showing who really gets the last laugh in such a scenario.

Can you believe some people will go to the extent of submitting a forged death certificate? This is that client who decides to fool the insurance company by submitting a false claim. These false claims occur in numerous ways, but to avoid giving anyone ideas of how to make money only that example will be made. Like many fraudulent actions, most are discovered, but you get the few that are so ingenious they slide by. As you can well imagine when fraud is on the rise businesses have to find a way of cushioning themselves (which in the insurance sector may be by increasing premiums), the cost of doing this will in most instances be transferred to the consumer. So whilst trying to fool the insurance company, guess who really ends up the fool?

Just like in that song mentioned in the first paragraph, the underlying objective of this article is to discourage and warn any would-be fraudsters. Just before you plan to commit fraud and you think you can get away with it ask yourself “who’s really fooling who?” To those honest insurance clients out there, it is almost guaranteed that your honesty will be rewarded and indeed crime does not pay but, as well, know that insurance does. As for the corrupt intermediaries which continue tarnishing the image of the other hardworking and diligent intermediaries, shame on you. Lastly, the writer wishes all insurance companies, clients and intermediaries a fool free 2008.


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