One challenge that faces the funeral and life insurance industry is fraud, and it’s growing. According to the comprehensive fraud statistics for the industry, released by the Forensic Standing Committee of the Association for Savings and Investment South Africa (ASISA) in November, the increase in fraud is concerning. But it’s not all bad news.
South African life insurers and investment companies detected 13 074 cases of fraud and dishonesty in 2023, a 46% increase from the previous year when 8 931 cases were detected. The industry lost at least R175.9m to fraud and dishonesty in 2023, a 128% increase from the R77m lost in 2022. Early detection of fraud and dishonesty prevented losses worth R1.5bn in 2023, compared to R1.1bn in 2022.
Following a complete overhaul last year, the statistics also cover fraud reported by investment companies in addition to the fraudulent and dishonest claims statistics reported by life insurers. Jean van Niekerk, convenor of the ASISA Forensic Standing Committee, attributes the steep increase in fraud detected in 2023 to a combination of the following:
Ongoing innovation of detection methods by forensic departments
Increasingly desperate consumers willing to commit a crime for extra money
Criminal syndicates who see life insurers and investment companies
as lucrative soft targets.
Van Niekerk says it is vital for the savings and investment industry to ensure that fraud remains in check to prevent fraud-related losses from spiralling out of control and higher claims rates from driving up premiums for honest policyholders. “Seen in isolation, the fraud statistics paint a bleak picture. However, they should be considered as part of the bigger industry picture, which shows that most policyholders and beneficiaries are honest. This is evidenced by the 95.9% payout rate in 2023 to the beneficiaries of 892 817 life and funeral cover policies to a value of R39.9bn.”
Van Niekerk explains that many life insurers and investment companies have dedicated forensic departments focused on clamping down on fraud and dishonesty by identifying criminal trends as they emerge. “A loss of R175.9m to fraud and dishonesty is significant, and our industry is focused on clamping down on criminal activity through continuous evolution and adaptation.”
According to Van Niekerk, preventative measures deployed by life insurers and investment companies include using digital technology such as artificial intelligence, improved industry collaboration, and enhanced authentication mechanisms such as biometric customer identification.
In addition, forensic departments share data on criminal activity via industry bodies geared to facilitate data sharing to combat fraud and financial crime, including the ASISA Forensic Standing Committee.
Fraud and dishonesty in 2023
The ASISA fraud statistics are divided into five categories:
Remuneration fraud: Fraudulent attempts by call centre agents, tied agents or independent financial advisers (IFAs) to benefit from commission and/or fees
Fraudulent applications: Fraud and dishonesty committed at the application stage through misrepresentation, non-disclosure, impersonation or identity theft
Fraudulent and dishonest life insurance claims: Fraudulent or dishonest attempts to claim benefits from risk policies such as life and disability cover
Fraudulent withdrawals and disinvestments: Accessing investments by fraudulent means from linked investment service providers (LISPs), collective investment schemes (CIS), and retirement funds
Other fraud: Examples include fraudulent attempts to obtain investment policy benefits and bribery and corruption.
Van Niekerk says more than half of all fraud cases recorded by ASISA members in 2023 were classified as remuneration fraud. Fraudulent and dishonest life insurance claims were the second-highest contributors to fraud cases in 2023. “Unfortunately losses jumped From R17m in 2022 to R69,8m in 2023, driven largely by fraudulent death claims,” he explains.
According to Van Niekerk, there was also some good news in the 2023 statistics.
“The numbers show a welcome decline in fraudulent applications and actual losses.”
Van Niekerk also reports a decrease in fraudulent withdrawals and investments, but a concerning increase in actual losses recorded, which jumped from R23,7m in 2022 to R40,5m in 2023.
New and concerning trends
Van Niekerk says two concerning trends that have emerged in recent years are murder for insurance payouts and deceased estate fraud. “We have requested ASISA members to report on these cases separately, starting with the 2023 statistics, to help our industry find ways to clamp down on these cases with urgency.”
Murder for insurance payouts
Van Niekerk says murder is an incredibly serious crime, and committing insurance fraud to benefit financially from someone’s death is not only highly callous but also premeditated to the extreme. He adds that while criminals often see insurance as a highly lucrative target, cases involving premeditated murder to benefit from an insurance payout are not that common. Out of the 4 130 insurance fraud cases reported for 2023, 14 cases related to the involvement of a beneficiary in the insured’s death. “Every death is one too many, and life companies are constantly updating their processes to ensure that risk policies are taken out only by honest policyholders to provide for their families. Unfortunately, someone with criminal intent will always find a way of cheating the system and hope to get away with it. Sadly, their modus operandi often involves family members or vulnerable or desperate members of society.”
Van Niekerk points out that the recent case involving a police officer in Limpopo and others like the Rosemary Ndlovu case have shown that criminals are highly unlikely to get away with this type of crime. “While life companies pick up on this type of crime very quickly through their data-sharing initiatives, the process of gathering evidence and building a case that will stand up in court is often a slow process. While the Limpopo arrest has occurred recently, the investigation was prompted by an alert from life companies many months ago.”
Deceased estate fraud
Life insurers and investment companies have noticed a new trend whereby criminals target deceased estate benefits and investment accounts. In 2023, life insurers reported 20 cases and investment companies 34 cases. Van Niekerk says deceased estate fraud is committed by impersonating legitimate parties and fabricating letters of executorship and other documents, as well as opening fraudulent bank accounts in the names of beneficiaries by impersonators and false executors.
