Insurance Fraud and Burns Claims: When Can an Insurer Reject Your Claim?

By: Attorney Michael Lev

Case Overview

An insured person filed a claim for serious burn injuries under their accident or personal injury policy. The insurance company rejected the claim, alleging that the circumstances of the injury were suspicious and that fraud was involved. The claimant challenged the rejection in court, where the insurer was required to prove its fraud allegations through concrete evidence.

The Legal Standard: What Must an Insurer Prove to Allege Fraud?

Under Israeli insurance law, an insurer that wishes to deny a claim on grounds of fraud carries a heavy burden of proof. Key principles include:

• High standard of proof: Fraud allegations require evidence that significantly outweighs mere suspicion. Courts demand proof beyond reasonable probability.
• Circumstantial evidence: Insurers often rely on inconsistencies in the claimant’s account, the nature of the injuries, or inconsistencies with medical findings.
• Causation: The insurer must show a direct causal link between the alleged fraud and the claimed event.
• Good faith obligation: Even when investigating suspected fraud, the insurer must act in good faith and process the claim expeditiously.

Lessons for Insured Persons Facing Fraud Allegations

If your insurer rejects your claim on fraud grounds, this does not mean you have no recourse. Courts regularly overturn such rejections when the insurer fails to provide sufficient evidence of fraud. Key steps include:

1. Obtain independent medical evidence documenting your injuries thoroughly
2. Document all circumstances of the incident in writing immediately after it occurs
3. Cooperate fully with the insurer’s investigation while preserving your legal rights
4. Do not accept a fraud-based rejection without consulting an insurance claims lawyer

Frequently Asked Questions

If your insurance claim was denied due to fraud allegations, contact the Lev-Taieb insurance claims team today. Call 03-609-0958.

Further reading: Insurance Claims | National Insurance | Case Results

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