Fraud is getting smarter, more networked and more digital and the insurance industry is responding with a national platform designed to spot patterns across insurers before suspect claims are paid. In that escalating battle, the Insurance Council of Australia (ICA) says brokers are a critical first line of defence.
At the Claims Leaders Summit in Sydney on May 12, Andrew Gill (pictured right), the ICA’s CEO of counter fraud and scams, is set to address the industry as claims teams grapple with the implications of AI, fraud and this mounting pressure on claims integrity.
In November, the ICA announced a collaboration with Shift Technology and EXL to build a national fraud detection and investigations platform coordinated through the Insurance Crime Intelligence Network of Australia (ICINA), with motor claims the first focus. The ICA said the platform will be a secure, real-time intelligence-sharing system and involve coordinated investigations across insurers.
The move could be a signal that Australia’s insurers are moving into a new phase of the fraud fight, one that looks less like chasing isolated bad claims and more like tracking organised behaviour across the market.
The ICA said its members detected $560 million worth of opportunistic insurance fraud in motor and property in 2023, while undetected fraud was estimated to cost the industry about $400 million a year, a burden that ultimately feeds into premiums.
“What concerns us most is the growing sophistication of organised fraud networks targeting multiple insurers through digital channels, combined with rising opportunistic fraud as people inflate otherwise legitimate claims,” said Gill.
The ICA has said fraudsters have adapted to the industry’s digital transformation, with organised networks exploiting online services with increasing sophistication.
The strategic importance of the platform is that it treats fraud as a cross-market data problem rather than a case-by-case claims problem. The ICA said the new system will let insurers securely share fraud patterns and coordinate investigations, using advanced analytics to alert investigators to suspicious activity in real time. It has also pointed to comparable programs already operating with insurer associations in the UK, France, Canada and Hong Kong.
For brokers this means fraud detection is likely to be more data-led, with greater scrutiny of inconsistencies across applications, claims histories and digital behaviours. The market may also expect brokers to play a more active role in noticing suspicious activity before a questionable claim gathers momentum.
“Brokers are a critical line of defence,” said Gill.
The ICA said brokers are often first to identify inconsistencies in claims or applications and has encouraged them to report suspicious activity to insurers and to ICINA.
There are also broader reputational and commercial reason this initiative matters to the industry. The ICA has repeatedly linked fraud control to affordability, arguing that reducing fraud helps reduce upward pressure on premiums for honest customers. Gill said every fraudulent claim paid is ultimately a cost borne by honest customers through higher premiums. The ICA’s new platform suggests the industry believes the next phase of fraud prevention will be fought less through isolated investigation and more through connected data, real-time alerts and better reporting from the front line.
