For decades, Australian insurance fraud may have been the perfect crime. Individual insurers would identify a dodgy claim, refuse to pay it and watch the same offender walk into a competitor's office the next morning to try again. The police, handed isolated cases on a piecemeal basis, would shrug. The consequence for getting caught was often simply not getting paid — hardly a deterrent for organised criminals running ghost claims across the industry.
That equation has now shifted. At the recent Claims Leaders Summit in Sydney, a panel featuring Andrew Gill (pictured left), CEO of counter fraud and scams at the Insurance Council of Australia (ICA), alongside leaders from RACQ, Bupa Health Insurance and Guidewire, revealed that unprecedented cooperation between insurers is — for the first time — building briefs of evidence robust enough to put fraudsters behind bars.
According to industry estimates, general insurers uncovered roughly $250 million worth of fraud in motor, home and contents last year, with another $50 million identified through the ICA's cross-industry work — bringing the known total to around $300 million. That figure likely represents the tip of the iceberg: detection rates in Australia sit at roughly 1% of claims, compared with around 5% in the United Kingdom, suggesting the true exposure could be many multiples higher.
The character of the threat is also shifting. Guidewire's senior director and industry advisory lead, Michael Anderson (pictured right), opened the panel with the now infamous deepfake video case involving Arup, the UK-headquartered engineering firm that helped design the Sydney Opera House. In 2024, fraudsters using AI-generated video and audio to impersonate senior executives, including the CFO, during a live conference call, tricked an employee in Hong Kong into wiring US$25 million.
However, while AI deepfakes and synthetic identities grab the headlines, Gill argued the more pressing problem is mundane and very human.
"I call the criminals, especially the organised criminals in Australia, very organised but not particularly sophisticated,” he said.
The same vehicles, the same damage photos, the same fake injury claims are recycled across multiple insurers. The fraudsters' core bet has always been that insurers don't talk to each other.
That bet is no longer paying off. Gill is a former NSW Police officer who led the landmark Strike Force Ravens. By way of example, he said part of that insurance fraud operation included the arrest and imprisonment of 21 individuals, including lawyers, doctors and physiotherapists, that collectively removed $400 million in fraudulent CTP claims from the system.
With the ICA, Gill has spent the past two years dismantling the cultural and regulatory excuses that have kept insurers’ fraud challenges siloed. Chief among those excuses has been the Privacy Act.
"The Privacy Act is not designed to stop insurers from talking to each other — it just provides the framework through which we can," said Gill.
Once that misconception was challenged, the floodgates opened. Measured cooperation between insurers has increased very dramatically, said Gill. The result: tens of millions of dollars in fraud identified and a cross-industry data analytics product now rolling out from motor into pet, travel and home contents lines.
More importantly, the police are finally listening. Where individual insurers were once turned away at the station, consolidated briefs of evidence now command attention. Gill told the panel about one striking example (no pun intended) — a claimant whose house, according to records pieced together across multiple insurers, had reportedly been struck by lightning 41 times. The matter, he said, was among those now drawing 100% take-up from police."
The behavioural shift this creates is, Gill argued, the missing piece of the puzzle.
"That's what's been missing, I think, in this whole insurance ecosystem for a long time, is that consequence,” he said.
When the worst outcome was a declined claim, fraudsters simply moved on to the next insurer. Now, with lawyers, doctors and physiotherapists being convicted and jailed the calculus has changed.
Backed by the CEOs of every major insurer through the ICA board and armed with technology, the message to organised fraud syndicates is no longer "we won't pay" — it's "we'll arrest you, we'll jail you and we'll take the money back."
For an industry that has been trying and failing to crack this problem for three decades, the sword of Damocles Gill describes is, at last, beginning to drop.
