DRAFT
ACPO/ABI GUIDELINES ON THE EXCHANGE OF INFORMATION BETWEEN THE POLICE AND INSURANCE COMPANIES AND LOSS ADJUSTERS
GUIDANCE NOTE FOR ABI MEMBERS
Background
- In 1978 the ACPO Crime Committee issued guidelines on the exchange of information between Police and insurers. In 1999, ABI and ACPO agreed to draft revised guidelines in recognition that the current system was not working well in practice. The joint ABI/ACPO Working Party has now agreed a set of revised guidelines. They are intended to complement the joint ABI/ACPO document “Acceptance Criteria and Guidelines for the Reporting of Suspected Fraudulent Insurance Claims to the Police”.
- The arrangements agreed in 1978 were felt to be inadequate because the Police were overwhelmed by the volume of requests for information received from insurers and loss adjusters and the administratively burdensome way in which they were made. The Police considered that in a large number of cases it was not made clear to them that there was suspicion of crime, namely insurance fraud, leading to the request. It is in insurers’ interests to build a workable protocol for requesting information from the Police so that cases where they have evidence or reasonable grounds to suspect fraud are dealt with.
- Paragraph 2.7 of the “ACPO/ABI Guidelines On The Exchange Of Information Between The Police And Insurance Companies And Loss Adjusters” (the Guidelines), sets out that ABI will provide additional guidance to its members in respect of applying to the Police for information under the Guidelines. This Guidance Note provides that additional material.
Complying with the Guidance Note
- ABI has agreed with ACPO that requests from insurers and loss adjusters will only be responded to by the Police if they comply with the guidance set out in this Note and the Guidelines themselves, and if requests are made by on or on behalf of the list of participating insurers at Appendix A to the Guidelines.
- This Note refers to “insurers” but the term should be read as including loss adjusters acting on behalf of insurers. As ABI members, insurers are responsible for ensuring that loss adjusters acting on their behalf comply with the terms of the Guidelines and this Note.
Basis for requesting information
- The Guidelines set out that there are two bases on which insurers should approach the Police for information:
• Where there is specific reason to check a claim (section 4);
• Where there is evidence to suspect a fraudulent insurance claim (section 5).
- Approaches to the Police should not be made where no crime is suspected. Insurers – or loss adjusters working on their behalf – who make approaches to the Police which do not comply with the Guidelines or this Note risk being deleted from the list of participating insurers at Appendix A of the Guidelines with the result that the Police will not supply any information to them or their agents.
Correspondence
- All requests for information must be made according to the agreed format set out in the Appendices to the Guidelines. No other correspondence except in the form of relevant supporting information sent with the appropriate form should be sent to the Police. In particular, the Police do not wish to receive letters registering the insurer’s interest in a particular case. Dealing with correspondence, even where no reply is expected or appropriate, is an unnecessary burden on Police time.
- Loss adjusters will need to confirm to the Police that they are requesting information as an appointed agent of a named insurer who appears on the list at Appendix A to the Guidelines.
- Paragraph 21 of this Note sets out that the Police also wish to be informed about the outcome of an insurer’s investigations where information had been requested under section 5 of the Guidelines.
Section 4: Supply of information where there is specific reason to check a
Claim
- This section relates to cases where the insurer has grounds to be suspicious of a claim but where there is not yet enough evidence to make a reasonable decision that fraud is being attempted. A crude example might be that goods reported stolen in a burglary appear to the insurer to be well beyond the means of the claimant (eg. very expensive items of jewellery belonging to someone in a modestly paid job) and the claimant has been unable to provide any proof of ownership. In these circumstances the insurer might have reasonable grounds to consider that the claimant could be making a fraudulent claim. A Police crime report could provide additional evidence to strengthen or weaken that suspicion.
- Requests under this section require the explicit consent of the insured for an approach to be made to the Police. Clearly this could make the ability to request information useless because a claimant would be extremely unlikely to give consent where they were aware that a crime report would not back up an insurance claim. To deal with this the insurer should seek the insured’s consent at two stages:
• Firstly, at proposal stage, the insured should be notified that, with the consent of the insured, the insurer might exchange information with the Police where this is needed to validate a claim;
• Secondly, at the point of claim, explicit prior consent must be obtained before information can be requested from the Police but settlement of the claim can be made dependent on consent being given if the insured had been notified at proposal stage.
- The insurer must satisfy themselves that true and explicit consent has been properly and appropriately obtained.
- All requests for information must be made in the agreed format shown at Appendix D of the Guidelines. This takes the form of a “Request To The Insured For Consent To Disclosure Of Information Held By The Police”. The insured is hereby shown the Request Form which will be sent to the Police so that their consent or otherwise is explicitly obtained on the exact information about them which will be passed from the insurer to the Police. They can also indicate if they wish to see an exact duplicate of the information which is sent by the Police to the insurer in response. If the insured gives consent then the original Form D should be sent to the Police.
- Form D requires reasons to be given for why the information is requested. A short summary of the grounds for making a suitable check must be given so that the Police can understand that it is appropriate for them to respond. Using the example above, a reason might be, “Exceptionally valuable items claimed for, no proof of ownership supplied, sum insured is very modest.” The insured will see this in advance when consent is requested.
- Because requests for information under this section are not based upon firm evidence that a crime is being attempted, the Police will charge a fee of £75 for each request made to cover administrative costs.
Section 5: Supply of information where there is evidence to suspect a fraudulent insurance claim
- This section relates to cases where the insurer has evidence to support their suspicion of insurance fraud. Requests for information from the Police will be made under s29 of the Data Protection Act 1998.
- In these cases the explicit consent of the claimant is not required in order to request information from the Police.
- All requests for information must be made in the agreed format shown at Appendix E of the Guidelines. The insurer will be required to summarise the evidence that they have and supply copies of supporting documentation to the Police. Requests for information are only likely to fall under section 5 of the Guidelines where the insurer has carried out some detailed investigations into a claim.
- No fee will be charged for requests made under this section.
- The Police have asked that where they have supplied information in response to a request under section 5 of the Guidelines, the insurer should in due course inform the Police of the outcome of their investigation and the claim. Where the insurer feels they have proven a fraud the Police should be presented with the file of evidence. Where the insurer has decided not to pursue the matter they should inform the Police accordingly.