Fraud

Fraud is defined as the act or omission of an act designed to gain an unfair or unlawful advantage for the party committing the offense of fraud or for the benefit of other parties.

A. Misappropriation of assets.
B. Deliberate misrepresentation or failure to disclose a previous conception or design of        a material fact.
C. Abuse of authority, a position of trust, or any fiduciary relationship.
D. Deliberately concealing and distorting documents or providing false information.
E. Exaggerating losses or intentionally damaging property and products
    with the aim of earning compensation amounts.

•  High insurance premiums.
•  The cancellation of the insurance policy and the suspension of the insurance coverage        of the client in the event of fraud detection.
•  Increasing the time taken to settle losses due to the increase in procedures.
•  Refusal of insurance claims and loss of compensation value.
•  Taking legal action against fraudsters. – Financial losses for the insurance company            are reflected negatively on its continuation of the activity.

The Saudi Arabian Cooperative Insurance Company (SAICO) takes strict measures to prevent all forms of insurance fraud, and is keen to develop an integrated methodology to discover this process, through:

• Developing and implementing an information system for fraud control.
• Allocating an integrated team to follow up on reports managed by the specialized             anti-fraud unit team.
• Cooperating with the regulatory and legislative authorities in the Kingdom, such as           the Central Bank of Saudi Arabia (SAMA)and the Health Insurance Council (CCHI).
• Allocating a free email and phone number around the clock to receive fraud reports.

To help us confront insurance fraud, we place great emphasis in fraud prevention on the awareness and cooperation of our customers and members of the community around us, where these acts can be prevented and combated by directly reporting any suspected actions to the specialized fraud unit, through one of the available official channels. Frauds can be curbed by:

• Do not share your insurance data with any third party to benefit from it, and do not           allow your insurance card to be used by anyone else.
• Avoid financial temptations from service providers to convince you to profit from               insurance, in an attempt to reap benefits through insurance fraud.
• Carefully review the claims and bills sent to you by the insurance company, and always       inquire about the cost of procedures that were not presented to you.
• When any fraudulent act is suspected or discovered; Inform the company directly via         the available channels.

The Saudi Arabian Cooperative Insurance Company (SAICO) undertakes to maintain the confidentiality of information and materials related to fraud, and not to misuse such information received or maintained, and pledges to maintain the confidentiality of the data of the person reporting fraud in insurance. It also pledges not to disclose all information provided except for the supervisory authorities and parties related to the case who need to review it if necessary.