Fraud in the field of insurance under Art. 159.5 of the Criminal Code of the Russian Federation: definition and types of crime, penalties, examples of 5 popular schemes, algorithm of actions of companies

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Article 159.5 of the Criminal Code of the Russian Federation - insurance fraud. Free answers from lawyers online.

At what point is it considered completed?

According to the Resolution of the Plenum of the Armed Forces of the Russian Federation dated December 27, 2007 No. 51 “On judicial practice in cases of fraud, misappropriation and embezzlement,” a crime that is insurance fraud is considered completed: from the moment funds are received or transferred to the account of the attacker or to the bank accounts of individuals who received money as a result of the illegal actions of a person who, through deception or abuse of trust, withdrew money from the victim, as well as after receiving a real opportunity to dispose of these funds.

Important nuances

To protect yourself from insurance fraud, you should:

On the clients’ part, refuse to participate in dubious transactions. These include any agreements that involve execution using forged documents and using outdated, false data. If the policyholder discovers that he has unknowingly become a victim of deception, it is recommended to report this to the insurance company as soon as possible.
On the part of insurance companies, at the stage of document preparation, check all data and certificates provided by policy buyers. Insurance fraud can be avoided if, at the stage of getting to know the scammers, you avoid trying to conclude a contract fraudulently.

Clients who have previously been convicted of insurance fraud are unlikely to be able to regain the trust of a financial institution. The same applies to a legal entity: information about companies using criminal schemes quickly spreads in the Russian insurance market. A damaged reputation in most cases means the collapse of an insurer's business, especially if it concerns regional firms.

Types of fraud in the insurance industry

Offenses in this area are divided into 3 main types:

against policyholders;
against insurers;
with the participation of insurers.

Fraud against insurers can be internal (subjects are employees of the insurance organization) and external (subjects are intermediaries and the clients themselves (beneficiaries)).

Types of fraud on the part of insurers include changes in the company’s financial indicators so that the authorized capital reaches the required amount. The most common cases of fraud are:

Fraud on the part of the victim (the victim independently causes the occurrence of an insured event, provoking the receipt of compensation).
Deception of the insurance policy holder (selling fictitious insurance, concluding agreements with false conditions for payment of compensation).
Pension insurance fraud:
fraudulent actions of private real and fictitious insurance companies, including the transfer of funds to the accounts of fictitious insurance companies and contracts that do not reflect the real terms of the insurance program;
false benefits.

The three main types of crimes in insurance are:

Murder (of the insured person, or a person similar to him, with the staging of an accident or insured event, in order to obtain payment).
Fraudulent actions concerning the material interests of the insurance company.
Accompanying the main accusation with the aim of making a profit in the form of insurance compensation:
false testimony (Article 307 of the Criminal Code of the Russian Federation);
substitution of documentation (p. 327 of the Criminal Code of the Russian Federation).
In auto insurance, there are frequent cases of fraudulent collection of money from insurance companies in court with the help of criminal auto lawyers (forgery of contracts, examinations, powers of attorney, and damage in road accidents occurs). Companies also lose large amounts of money if funds are written off from their accounts by court decision.

Fraudsters are divided into three categories:

Groups of people (including insurance company employees) who want to get money through insurance fraud.
Forms are manipulated, written off, deliberately damaged, premiums are deliberately underestimated, and collusion with clients is possible.
Individuals (policyholders) who deliberately deceive the insurance company.
Persons who committed fraudulent acts unintentionally.

Fraud against policyholders occurs both in real (by employees of the insurance company) and in fictitious (by employees and owners of fictitious insurance companies). For each of the subjects there are different types of crimes , and their number is quite large:

fraud (Article 159 of the Criminal Code of the Russian Federation);
damage or theft of documentation, seals, stamps (Article 135 of the Criminal Code of the Russian Federation);
abuse of power (Article 201 of the Criminal Code of the Russian Federation);
commercial bribery (Article 204 of the Criminal Code of the Russian Federation);
illegal misappropriation or waste (Article 160 of the Criminal Code of the Russian Federation);
forgery of official status (Article 292 of the Criminal Code of the Russian Federation);
bribery (Article 291 of the Criminal Code of the Russian Federation);
illegal business activity (Article 171 of the Criminal Code of the Russian Federation).

The essence of insurance fraud

Insurance fraud is common. Both individuals who have entered into an agreement at the insurer’s office and companies can meet face to face with scammers.

The essence of insurance fraud is the fraudulent appropriation of payments, premiums and material compensation under the insurance contract. Subjects of insurance fraud can be:

Clients – policyholder, insured person and/or beneficiary.
The insurer is a legal entity.
The third party is interested parties. Brokers, acquaintances of the “victims”, law enforcement officers, witnesses of the insured event.

Insurance fraud can occur in and out of the office. It most often occurs at the stage of receiving compensation, for example, when trying to inflate the amount of damage in order to obtain the maximum amount of insurance coverage.

Corpus delicti

The object of fraud is public relations in the field of insurance, that is, the protection of the rights of individuals and legal entities at the expense of the insurance fund in the event of an insured event.
The subject of these relations is considered to be any property, including money, controlled by the insurer and which is illegally claimed by the guilty person. Sometimes the subject is not money, but a specific object, if the terms of the contract do not provide for the issuance of compensation upon the occurrence of an insured event, but the replacement of payment with property, the value of which is equal to the amount of compensation.
The objective side is theft of property, that is, the act of the culprit, as a result of which the appropriation of someone else’s property is committed; consequences and connections in case of theft and damage to the owner; deception regarding the occurrence of an insured event, and therefore the amount of payment.
Subject is an individual of sound mind at least 16 years old (a valid contract is required).
The subjective side is the guilt of the subject, that is, an intentional act with the aim of appropriating the property of another person. The culprit, with selfish goals, seeks to dispose of or appropriate someone else’s property, while being aware of the illegality of his actions and the consequences.

Features of doing business

Evidence of criminal intent is not easy to gather for this article. Liability was introduced due to the increasing number of cases of significant damage to insurance companies due to fraudulent activities. In most cases, proceedings under Article 159.5 are opened after auto-fraud has been committed.

You should not assume that a case is opened by itself after a crime has been committed. Usually, in order to initiate the collection of data on such a crime, it is necessary to write a statement of suspicion of having committed a crime; a sample can be obtained from the prosecutor's office or from insurance lawyers.

The following persons have the right to file an application for fraudulent actions:

Insurance Company;
a person whose money was misappropriated by swindlers;
an insurance employee who was pressured by an official.

The investigation into the case is being conducted by the Ministry of Internal Affairs of the Russian Federation and the Investigative Committee of the Russian Federation, and the pre-investigation check is carried out by operational officers.

In order for a case to go to trial, they need to collect the following information:

Presence of criminal intent.
The presence of a conspiracy.
The fact of receiving funds.
The fact of illegal acts in relation to a person or property.
Falsification of documentation.

The specialists leading the case will need to collect all the evidence of a person’s involvement in the crime, information about witnesses and possible assistants. If there is not enough evidence to transfer the case to court, then it will fall apart at the investigation stage.

Moreover, if the citizen did not receive the money, the crime will not be considered completed. Then the case will be reclassified as attempted fraud or the proceedings will be closed altogether.

It is necessary to pay attention to the fact that if there was no conspiracy and violation of someone’s rights, the money was not received, but the documentation submitted by the citizen was drawn up incorrectly and contained false information, then a case may be opened under Articles 327 and 159 of the Criminal Code of the Russian Federation.

Responsibility under Art. 159.5 of the Criminal Code of the Russian Federation

Insurance fraud is classified as a crime committed in the field of legal relations of insurance activities. According to Art. 8 of the Criminal Code of the Russian Federation, the cause of criminal liability in this area is considered to be the implementation of an act that contains all the elements of a crime provided for in Article 159.5 of the current Criminal Code. To be held accountable, the amount of theft must be at least 2,500 rubles.

5,000 rubles and above – considered as “significant damage”;
1,500,000 rubles – “large-scale theft”;
6,000,000 rubles – “extra large size”.

Punishment – fine up to:

Part 1 of Article 159.5 of the Criminal Code of the Russian Federation .
The basis for criminal liability is the commission by a citizen who has reached 16 years of age of unlawful appropriation of the property of another person through deception regarding the occurrence of an insured event and the amount of payment. Punishment – a fine of up to 120,000 rubles, the perpetrator’s salary for 1 year, correctional labor for up to 1 year, or restriction of freedom for up to two years.
Part 2 art. 159.5 of the Criminal Code of the Russian Federation . If the same act was committed by a group of persons by prior conspiracy, and the victim suffered significant damage, the fine is up to 300,000 rubles or wages are charged for up to 2 years, correctional labor lasts up to 2 years, imprisonment for up to 5 years.
Part 3 of Article 159.5 of the Criminal Code of the Russian Federation . If a person commits the offenses specified in parts 1 and 2, using his official position and on a large scale, the liability will be as follows: a fine - 100,000-500,000 rubles, wages for a period of 1 to 3 years or imprisonment for a period of up to 6 years and a fine of 80 thousand rubles (we talked more about fraud using official position and responsibility for it here).
Part 4 of Article 159.5 of the Criminal Code of the Russian Federation. If the acts specified in parts 1, 2, 3 of the article are carried out by an organized group and on an especially large scale, a punishment of up to 10 years in prison and a fine of up to 1 million rubles is provided.

Who most often becomes a victim of cybercriminals?

As it turned out, in insurance crimes committed by employees of insurance companies against their clients, the victims, of course, are inattentive naive citizens who do not read or read but inattentively insurance contracts. They do not review documents received from an insurance agent or insurance company representative. For example, an attacker posing as an insurance agent (or actually being one), in order to attract a victim, sets the price of an insurance policy significantly below average, although in reality such a policy does not exist, it is fake, although it has all the features of a real insurance policy form. In another case, the policy may be valid, real, but the insurance agent, misleading the victim, sells the policy supposedly for a year, but in reality the policy is valid for a much shorter period, which is not reported to the naive, inattentive victim.

“As a rule, the damage to citizens from such crimes is no more than 1 million rubles. However, if we are talking about committing a crime against an insurance company, then the amount of damage caused may be significantly higher.”

Action tactics

When identifying fraudulent activities in the insurance industry, the practice of seeking help from law enforcement agencies is not very common. This is due to the fact that in most cases the insurer tries to solve the problem out of court.

In addition, the fact that the line between determining fraudulent and non-fraudulent activities is very thin can serve as an obstacle. For example, if there is a fact of deception, but it is unintentional, it cannot be classified as fraud.

However, if a person has become a victim of criminal acts, it is necessary to contact law enforcement authorities.

Where to contact?

A police report is filed if the identity of the offender is unknown.
The task of the police is to identify the attacker, find and detain him and find irrefutable evidence of guilt. In most cases, statements are accepted if evidence proving guilt is discovered, a criminal case is opened and police officers transfer the case to the prosecutor's office.
The main function of the prosecutor's office is supervision, so this body is contacted if other bodies fail to use the right to defense. An application to the prosecutor's office is written to check a person who uses fraudulent actions against his clients or for administrative pressure on the police.
They go to court when the identity of the attacker is known and there is evidence of his guilt, in order to determine and assign a measure of responsibility. If you immediately write a statement to the court, the case will be resolved much faster. The available evidence is attached to the application; in such cases, collecting evidence is the most difficult task.

Statement

An application to initiate a criminal case for fraud is written by hand or printed.

The header indicates the name and position of the head of the authority to which it is submitted and the name of the institution itself.
Next, the applicant indicates his data (full name, address, phone number).
The word “Statement” is written under the heading.
The main part includes the date and place of the offense and an accurate, detailed description of the circumstances. It is the circumstances of the case that make it possible to classify it as insurance fraud.
Next, they indicate the article, according to which they are asked to initiate a criminal case and return the stolen property.
If evidence is attached to the document, all of it must be listed in the appendix.
At the end, put the filing date and signature.

Legal settlement

Art. 35 of the Law of the Russian Federation on Insurance, indicates that cases related to insurance are considered by arbitration and arbitration courts . A court of general jurisdiction accepts cases between an insurer and an individual, and arbitration courts hear disputes between legal entities.

In addition, the amount of the claim also affects jurisdiction. If it does not exceed 50,000 rubles, you should contact the magistrate court, and if this amount is exceeded, the district court. When going to court, the plaintiff must have more than just evidence in his hands. The following is attached to the application:

insurance policy and contract;
documents confirming the right to the insured property;
receipt of state duty.

The amount of the state duty depends on the value of the claim:

if the theft amounted to less than 20,000 rubles, the duty will be 4% of the amount, but not less than 400 rubles;
a claim worth from 20,000 to 100,000 rubles costs 800 rubles and 3% of the amount over 20,000 rubles;
from 100,001 to 200,000 rubles - the duty is 3,200 rubles and 2% of the amount over 100,000 rubles;
from 200,001 to 1,000,000 rubles – 5,200 and 1% of the amount over 200,000 rubles;
if the size of the claim exceeds 1,000,000, the state duty is 5,200 rubles and 0.5% of the amount over a million, but not more than 60,000 rubles.

What can be used as evidence?

According to Art. 74 of the Criminal Procedure Code of the Russian Federation, the court accepts as evidence:

Oral testimony of the accused and the victim . They must be logical, clear, consistent. If the facts do not coincide, the evidence is considered insignificant.
Attachments to the application . The more there are, the better. They include payment receipts, bank statements, contracts and receipts. All types of documents related to the case can be used. Special experts check documents for authenticity and issue an opinion, which is welcomed by the court.
Video and audio recordings . If possible, conversations with the attacker regarding the crime should be recorded. It is allowed to use recordings from hidden video cameras. Mail correspondence is also included in the list of evidence if necessary.

If during cooperation any documents are in doubt, photocopies of them should be made; this can also serve as evidence in the proceedings.

How are customers deceived?

It is not possible to immediately distinguish a false insurer from a real one. First, callers have access to insurance coverage. The interlocutor knows everything about the client’s car, his driving record, accident rates, details of his current policy, and can calculate the cost of insurance. Users assume that such information is sold on the black market on the Internet. Secondly, scammers very accurately imitate the work of call centers: background noise, conversation using scripts. Thirdly, they will persistently remind you about safety. For example, they will offer to pay for the service after receiving the policy from the courier and checking the document on the website of the Russian Union of Auto Insurers. The policy number is real, it is listed in the RSA database. However, another car owner is insured under it.