Resources
Case Studies
Fraudulent insurance claims
Dr J is a general practitioner in private practice. On one occasion, his friend Tony, an insurance agent, suggested to him a plan for earning quick money. The Personal Accident Insurance Policy (PAI) offered by his company would provide insurance compensation for an injury caused by an accident resulting in death, permanent or temporary disability to an insured. All claims under the PAI had to be supported by a form issued and signed by a registered doctor in Hong Kong. Tony knew many construction workers and, as a first step, he would suggest to them to buy PAI policies from him. These individuals would make claims later, even though they just suffered from minor injuries. What Dr J could help was to exaggerate the seriousness of the injuries when filling in the worker's claim forms as the attendant doctor, thus resulting in higher compensation payments. The “profit” could then be split among all parties.
Case Analysis
Dr J, Tony and the construction workers would commit an offence of conspiracy to defraud by colluding in making bogus insurance claims to deceive Tony’s insurance company for personal gain.
Dr J might violate Section 26.3 of the Code of Professional Conduct issued by the Medical Council of Hong Kong (Oct 2022) for issuing documents containing untrue information.