Insurance Industry Arms with AI to Outpace Scams

3

The Insurance Council of Australia (ICA) reports the insurance industry is burdened by an estimated $400 million in undetected fraudulent claims in 2023. Such costs inevitably burden consumers through higher premiums and collateral economic impacts.

A report from the US National Insurance Crime Bureau cited a staggering $9.2 billion in inflated disaster claims paid out in 2022 due to scams. ICA has reacted by empowering a specialist fraud prevention team under the leadership of former cybercrime detective Andrew Gill to crack down on organised scam operations.

The rising concern is the technological sophistication scammers employ. A new phenomenon known as “shallowfake” scams, highlighted in a recent Allianz warning, shows fraudsters manipulating images using simple tools like Photoshop to simulate damages, complicating genuine claim approval processes.

Diving deeper, the advent of generative artificial intelligence (GenAI) could complicate issues further. From augmenting photographs to creating realistic phishing attacks, GenAI is proving to be a powerful tool for bad actors. As Shift Technology's head of global partnerships, Drew Whitmore explained, fraudulent claims are reported 58% more often by scammers. “The severity of those claims is over eight times more than the standard,” he noted, demonstrating the intensity of the threat.

Social media platforms are not exempt from misuse, with fraudsters mining public information to craft credible yet deceitful claims. Abhi Bhola from EXL expressed that the era of easy access AI is contributing to diverse fraudulent approaches, warning, “Better AI, which is easily available, is fueling the threat.”

Fortunately, artificial intelligence offers a defense mechanism for insurers. By processing and analyzing vast datasets in real time, AI helps insurers promptly detect abnormalities and nefarious activities before they intensify. Collaborations such as the one between EXL and Shift Technology aim to enhance the precision of fraud detection across the sector.

Preserving the integrity of the insurance ecosystem requires proactive cultural transformations, according to Whitmore, If insurers cannot do that, leveraging any advanced technology will not help. He emphasises the necessity of moving from a reactive stance to forecasting and preemptive action.

The industry anticipates more regulatory cooperation in data-sharing strategies to foster effective anti-fraud measures. As Whitmore emphasized: that Fraudsters are sharing their information, and the industry needs a framework to do this, too.

By harnessing AI and building supportive industry partnerships, insurance companies can expect to mitigate fraudulent losses, protect their consumers’ interests, and uphold their role as trustworthy societal figures, thereby exemplifying positive conduct within their communities.

Published:Thursday, 17th Oct 2024
Source: Paige Estritori

Share this news item:

Insurance News

Clear

TAL Collaborates with Insurtech to Launch Embedded Life Insurance 17 Jun 2025: Paige Estritori Australia's prominent life insurer, TAL, has partnered with the global insurtech firm, Cover Genius, to introduce an innovative 'digital-only', embedded life insurance product. This new solution aims to serve Australian workers such as part-time employees, contractors, and casual staff who often lack access to affordable insurance coverage. - read more

Growing Mistrust in New Zealand Insurers Amid Rising Costs 17 Jun 2025: Paige Estritori Recent findings from a Consumer NZ survey highlight increasing skepticism towards insurers in New Zealand, as affordability remains a significant concern for many. The survey noted that insurance now ranks as the fourth-largest financial pressure among respondents, trailing housing, food, and household debt, marking an upward shift from sixth place last October. This change has negatively impacted the industry's reputation, with more individuals expressing distrust towards insurers. - read more

No Refund Policy Upheld in Camper Tent Dispute 16 Jun 2025: Paige Estritori The Australian Financial Complaints Authority (AFCA) has supported Open Insurance's decision to deny a refund to a customer who cancelled his motor policy after being informed that his new rooftop tent installation would breach policy guidelines. The policyholder was advised that any modifications, including a 'slip on camper/tent or camper conversion,' would void coverage, prompting him to cancel his insurance in March. - read more

Acenda Secures Four Key Wins at Life Insurance Excellence Awards 16 Jun 2025: Paige Estritori In a triumphant moment for Australian life insurer Acenda, the company secured top honours in four of the ten categories at the Australian Life Underwriting and Claims Association (ALUCA) Life Insurance Excellence Awards. Formerly known as MLC Life Insurance, Acenda emerged as a finalist in nine categories, ultimately winning the Leadership Award, Claims Team Award, Customer Service Team Award, and Partnership Impact Team Award. - read more

AFCA Upholds Insurer's Decision on Claimant's Non-Disclosure 12 Jun 2025: Paige Estritori A recent ruling by the Australian Financial Complaints Authority (AFCA) supported Auto & General's decision to deny a motor policyholder's claim after a crash. The decision stemmed from the policyholder's failure to disclose a driving-related good behaviour bond, despite his claims of a learning disability affecting his understanding of the policy's inquiries. - read more

Insurer Ordered to Cover Restaurant Arson Despite Director's Unrevealed Criminal Record 12 Jun 2025: Paige Estritori In a recent decision, the Australian Financial Complaints Authority (AFCA) directed insurer QBE to honour an arson claim for a restaurant, despite the owner's failure to disclose prior criminal convictions during the policy's inception. The restaurant, which operates from a leased location, suffered extensive damage due to an arson attack on August 2 of last year, halting its business operations. While the arsonist was apprehended, QBE initially denied the claim, citing non-disclosure of the director's criminal history. - read more

Insurance Sector Reports $1 Billion Profit Amidst Household Strain 11 Jun 2025: Paige Estritori The insurance industry secured a net profit after tax of $1.11 billion in the March quarter, with major contributions from insurers at $990 million and reinsurers at $123 million, as revealed by the latest data from the Australian Prudential Regulation Authority. The insurance service result, a key indicator of underwriting success, reached $1.32 billion during this period, while investment returns added an impressive $1.18 billion. - read more

ASIC Accuses Choosi Pty Ltd of Misleading Insurance Comparison Practices 10 Jun 2025: Paige Estritori The Australian Securities and Investments Commission (ASIC) has initiated legal proceedings against Choosi Pty Ltd, alleging deceptive practices in its insurance comparison service. The regulatory body charges that from July 2019 to June 2025, Choosi misrepresented its offerings, claiming to compare funeral and life insurance policies from multiple insurers while actually only comparing products from a single provider, Hannover Life Re of Australasia Ltd. - read more

Individual Disability Income Insurance Extends Profitable Streak into Fifth Quarter 10 Jun 2025: Paige Estritori Recent figures from the Australian Prudential Regulation Authority reveal that individual disability income insurance (DII) recorded an underwriting profit of $231 million for the first quarter of 2025, continuing a five-quarter streak of profitability. This performance shows promising growth compared to the December 2023 quarter, which saw an $86 million loss. Although the latest profit is up from $138 million in the last quarter, it still falls short of the $419 million achieved a year before. - read more

AFCA Overrules Insurer in Camper Trailer Damage Case 09 Jun 2025: Paige Estritori The Australian Financial Complaints Authority (AFCA) has ruled that a camper trailer owner will receive coverage for water and mould damage after the insurer could not demonstrate that the wear and tear exclusions applied under the policy. The case emerged after a storm in November 2023, which the claimant says caused severe wind to rip the cover off the camper, allowing water ingress and subsequent mould development. - read more