Insurance fraud:
the patterns assessors look for on every claim.

In September 2025, the chairperson of Uganda's Insurance Appeals Tribunal told the industry that more than 40 percent of what insurers pay out in claims may be fraudulent — while noting, in the same breath, that genuine claimants were being frustrated by insurers. A KPMG study cited by the regulator put the national picture differently: insurance fraud adds roughly ten percent to the cost of every premium, and false claims had jumped 61 percent in a single year. Both claims are true at once. Fraud is widespread, and most claimants are honest. The discipline of loss assessment exists precisely at that junction — to find the fraud without delaying the genuine claim.

Why the assessor sits at the first line of defence

Most fraudulent claims are detected before payment, at the assessment stage, rather than after it. The assessor is the professional who photographs the damage, reads the documents, speaks to the witnesses and reconstructs the incident — which makes the assessment the natural place where manipulation either breaks or passes. Industry leaders have acknowledged both the scale and the sophistication of modern fraud. Fraudsters stage accidents by bringing cars from previous accidents together and photographing them as if the damage happened together; they forge documents to give non-existent losses a documentary life; they fake injuries to inflate personal injury losses; and in the worst cases they work with officials inside insurance companies to sign fraudulent claims off. As the Insurance Regulatory Authority of Uganda's CEO told insurers at a 2026 industry forum, fraud is now digital — including signatures forged with the help of artificial intelligence.

The patterns, claim class by claim class

Fraud follows recognisable patterns, and the assessor looks for the anomaly rather than the accusation.

• Motor — the highest-frequency class. Inflated estimates, repairs on top of pre-existing damage, vehicles reported stolen while still in circulation, and the staged accident. The assessor's checks are mechanical: compare the damage pattern with the reported circumstances, examine the condition of the vehicle for old damage, verify the vehicle's history and registration, and correlate the claim with the police statement and the wrecker's timing. Photographs matter — including today's warning that photographs themselves can be manufactured.
• Burglary and fire — inflation and arson. Stock lists that expand after the event, invoices of suspect provenance, master copies of documents, fire claims where the loss is far larger than the business's trading records would support, and thefts from premises whose security the insured was required to maintain. The file is tested against the business's own record — purchase ledger, sales, bank deposits — exactly as a fidelity shortage is reconstructed.
• Medical — the most loss-making class. Falsified diagnoses, treating one procedure as several, performing services that are unnecessary simply to bill them, and inflated invoices from unregistered facilities. The assessor cross-checks the claimed treatment against protocols, fees and the provider's own records.
• Personal injury — overstatement. Injuries asserted rather than demonstrated, medical reports obtained specifically for the claim, and demands for lost income that outrun the claimant's banking history. The medical evidence is tested against the reported mechanism of injury and the claimant's own account.
• Collusion. The fraudster who works with an insider — an insurer employee, a repairer, a medical provider — produces documents that look right; the anomaly then surfaces in pattern terms: claims against the same account in close succession, matching repairers, recurring claimants. This is why regulators urge insurers to maintain a fraud register shared across companies, so that a name that appears too often is caught by the industry rather than by one underwriter.

Documents: where the assertion meets the record

Every fraudulent claim needs a paperwork trail, and the trail is where it most often gives itself away. The assessor checks documents for the obvious and the subtle alike: inconsistencies between dates, sequences that do not fit the reported event, valuations and estimates that change between first report and inspection, invoices drawn up on the wrong stationery, and similarities to documents seen on other claims. Digitisation has changed the game — fraudulent documents can now be generated, and detection has followed with software and artificial-intelligence tools used by assessors to link claims and documents to known fraud patterns. The counter-intuitive point is reassuring: precisely because fraud must be documented, the paper trail is the assessor's greatest ally.

The verification discipline

The assessment treats every claim as genuine until the file says otherwise, and verifies systematically: the site and the damage; the persons and their statements; the documents and their provenance; and the economics of the business whose loss is claimed. Where circumstances are suspicious, the file is developed further rather than rejected early — a theft claim that cannot demonstrate that the goods existed, that no other party had access, and that the reported timing is consistent with the records, fails on evidence without any finding of dishonesty. Where fraud is patently demonstrated, the assessment documents it for repudiation and for the regulatory and commercial consequences which follow — including entry in the fraud registers that protect every other insurer.

The balance: fraud detection must not become claim obstruction

The same insurance sector that fights fraud has been scolded by its own regulator for making genuine claims hard. The IAT chairperson noted that many genuine claimants leave frustrated while the industry's attention is consumed by the fraudulent 40 percent. The regulator's message to loss assessors is direct and has been repeated publicly: rigorous detection of fraud, but never at the expense of a prompt, proper settlement of a genuine claim. The assessor's craft — and the integrity that underpins it — is to do both simultaneously: protect the fund that pays honest policyholders, and pay honest policyholders quickly.