Soat tops the ranking of the most fraudulent policies in Colombia

The Compulsory Traffic Accident Insurance Soat is not only one of the policies with the highest loss ratio and evasion, but it is also the one most used by some individuals to defraud the insurance industry in Colombia. Recent data from the Federation of Colombian Insurers Fasecolda indicate that up to November, insurers had paid out close to 2.4 trillion pesos for claims under this policy, 7.9 percent more than a year ago, while evasion of this insurance exceeded 55 percent.

Added to these figures is the fact that this insurance tops by far the ranking of policies with the highest cases of fraud detected by the sector, which between January and September last year exceeded 24,300 in total, of which nearly 62 percent corresponded to Soat 15,033 cases. The others are occupational risks 5,342, automobiles 1,301, health 787 and theft or robbery 627.
This volume of frauds reached an amount of 242,000 million pesos, of which the affected insurers had to cancel 12 percent, that is, about 30,000 million pesos, according to an analysis prepared by Lorena Ayala Cubillos, deputy director of Institutional Management against Fraud of Fasecolda.
The report also reveals that, in general terms, the regions where most cases of fraud against the insurance industry have been detected are, in order, Bogotá, Valle del Cauca, Atlántico and Antioquia.

Accidents that do not happen

The expert points out that in each of the lines of business, different fraud modalities have been detected, used by individuals to try to take advantage of insurance in an illicit manner.
Thus, for example, in the case of Soat, 35.08 percent of the cases detected correspond to inconsistencies in the documents provided at the time of the claim, in which the information associated with the victim, the vehicle involved or the services provided present irregularities.
"This is detected when verifying the occurrence of the accident", warns the expert, who points out that in second place, with 21.67 percent, are the cases in which a traffic accident never occurred and the vehicle was not involved in a road accident either.

Very healthy patients

The second policy that some people use the most to obtain a benefit without the claim as such, is the Labor Risks policy, another mandatory policy, this one for the country's workers.
According to Ayala Cubillos' analysis, in this insurance 47.15 percent of the cases detected by the industry are due to "opportunistic claims", a modality in which patients magnify their symptomatology to seek an extension in the incapacities and obtain a reinforced labor stability or even a change of position.

In the automobile line, more than 34 percent of fraud events also occur under the modality of 'opportunistic claims', in which the insured or a third party takes advantage of the claim, for example a collision, to repair problems that the vehicle has had due to lack of maintenance.
In second place, with 28.36 percent, are fictitious claims, i.e., those events that never occurred and are only due to a staging of the facts, fictitious accidents.

Double health charges

Health policies are also not spared from the traps of some people. According to the Fasecolda report, in only nine months of last year, 878 cases of attempted fraud were detected, of which 22.4 percent corresponded to planned claims, that is to say, in which the occurrence of the event for which the insurance claim was sought was prepared, and 19.4 percent were double charges for services that had already been billed.
As for the Theft or Robbery policies, 80.7 percent of the events corresponded to premature claims or when the term of the policy contracted was coming to an end.
of the contracted policy.
In view of this situation, the insurance industry has been implementing strategies to try to mitigate the scourge, often acting hand in hand with various authorities and entities in each of the sectors. As a result of this, not only has it been possible to capture people who were defrauding with the Soat, but also to revoke the authorization services of 24 health service providers in Atlántico, take precautionary measures against five institutions located in Santa Marta, Pereira and Valledupar, after identifying situations that put the life and physical integrity of the users at risk, especially those of the users.
and physical integrity of users, especially those related to victims of traffic accidents.
Given the ease with which these types of fraud mutate, the Direction of Institutional Management against Fraud has been leading specialized workshops in the branches of Soat, life, health, labor risks and automobiles, says the report of the guild, which indicates that these events not only allow to know the main problems of fraud, but also to share good practices and propose actions to mitigate the phenomenon.
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