Insurance companies detect €87 million in frauds in 2024, motor insurance leads with 13,000 cases
Portuguese insurance companies detected fraud totalling €87 million in 2024, with the motor insurance sector leading: more than 13,000 proven cases and €40 million in fraudulent claims.
Insurance fraud reaches €87 million in Portugal in 2024
Portuguese insurance companies identified, in 2024, insurance fraud valued at €87 million — an amount corresponding to claims deemed fraudulent that ultimately went unpaid. The figures come from the Portuguese Insurance Association (APS) and were reported by Jornal de Notícias, as reported by executivedigest.sapo.pt.
The motor insurance segment has emerged as the main focus, with more than 13,000 proven cases and claims valued at approximately €40 million. Across all the segments analysed by the APS — life insurance, workplace accidents, personal accidents, motor insurance and multi-risk policies — 154,000 suspicious claims were identified.
Number of suspicious claims rises 13% compared to 2023
The APS considers that the detected value reflects the evolution of detection and prevention mechanisms. Nonetheless, the figures point to growth in the phenomenon: compared with 2023, the number of suspicious claims increased by 13%.
An official source from the association, cited by Jornal de Notícias, confirms that the motor insurance segment continues to record more cases of proven fraud, but also more suspicious situations under investigation. The size of the segment contributes to the statistical weight, but the APS warns that the problem extends beyond false accidents or inflated damages in individual claims.
The most concerning fraud, the association emphasises, is organised fraud — and involves service providers in particular, rather than isolated individuals. Beyond motor insurance, there is significant incidence in multi-risk policies, workplace accidents and life insurance.
How insurance companies detect cases
Detection is based on internal alert systems. The so-called "alarmistics" can be triggered by several signals: repetition of claims associated with the same person, involvement of entities already linked to previous cases, or claimed amounts considered abnormal.
The APS explains that these mechanisms vary depending on the insurance segment and the accumulated experience of each insurance company, with the goal of identifying suspicious patterns before claims are paid.
Not all fraud is detected, however. When it goes undetected, the cost ends up being borne by the community of policyholders, reflected in premiums charged.
Insurance company may be obliged to pay despite fraud
In liability insurance, particularly in the motor insurance segment, protection of third parties injured has particular weight. Even in situations of fraud or breach of contract attributable to the policyholder, the law tends to safeguard the right of the injured third party to compensation.
In such cases, the insurance company may be obliged to pay the injured party, without prejudice to subsequently exercising its right of recovery against whoever committed the fraud or breached the contract terms.
Fraud can begin before the claim
Insurance fraud does not only occur at the time of claim notification or settlement. It can also arise during the underwriting phase, when the policyholder makes false declarations, omits information relevant to the assessment of the risk, or provides inaccurate data about the insured item or person.
Examples include false information about vehicle characteristics, the actual use of the insured item, state of health, professional activity or other circumstances that may alter the risk assumed by the insurance company.
Health insurance excluded from statistics
The APS analyses do not cover all segments of the insurance industry. Excluded are segments of minor significance or areas where fraud is more difficult to quantify, such as health insurance — where, according to the association, abuse coexists with fraud, but is difficult to measure with rigour.
Penalty can reach eight years' imprisonment
Insurance fraud is provided for in the Penal Code as "fraud relating to insurance". The crime occurs when someone causes, aggravates or simulates a claim to improperly obtain compensation — including intentional accidents, deliberate aggravation of damages, or injuries caused to claim compensation.
The sentence can be up to three years' imprisonment or a fine, increasing to eight years in the most serious cases. Attempted fraud is also punishable and criminal proceedings depend on a complaint.
The APS states it cannot confirm the existence of widespread public perception that defrauding an insurance company does not constitute a serious crime, arguing for greater consumer information to strengthen insurance literacy.
Source: Google News PT — Crime (pt)