Insurance fraud: turning doubt into evidence

Written by Guillaume Pouillier, CNAPS-licensed private detective, licence no. AGD 095-2024-03-06-20190240581 · Last updated: July 12, 2026

Anti-fraud has become a fully-fledged function within insurance companies, structured at market level by ALFA, the French anti-fraud agency. But between a handler’s alert and enforceable proof lies investigative work that only a licensed professional can lawfully carry out in the field. That is where we come in, supporting your inspectors, experts and counsel from our agency at 10 rue de la Paix (Paris 2nd). This page sets out what French law treats as fraud, the patterns we encounter most, how an investigation is conducted within the limits of privacy law, what the fraudster risks, and what the whole operation costs, so you can brief your claims committee with complete figures.

What counts as insurance fraud under French law?

Any manoeuvre aimed at obtaining an undue indemnity: an invented or provoked loss, inflated damage, a false declaration of the risk. An intentional false declaration voids the policy (art. L113-8 of the Insurance Code); completed fraud amounts to criminal deception (art. 313-1 of the Criminal Code).

French law carefully separates bad faith from error: an unintentional omission or inaccuracy (art. L113-9) merely reduces the indemnity, while proven fraud voids the policy retroactively, with premiums retained by the insurer. The whole value of an investigation therefore lies in establishing the intentional element: showing that the insured knew, prepared, concealed.

That is a question of method: dates, cross-checks, chronology. One isolated fact does not prove intent; a coherent series of findings does.

Which fraud patterns do we see most often?

The staged vehicle theft, the household claim padded with pre-existing damage, the well-timed fire in an unsellable property, sick leave combined with paid activity, disability that worsens as the expert appraisal approaches, and liability losses amplified by false certificates.

• Motor: “stolen” vehicle found back on the road, arranged accident between acquaintances, prior damage re-attributed to the declared loss
• Property: embellished inventories, accommodation invoices, the same loss declared to several insurers
• Protection / health: sick leave with continued activity (building sites, trade, online platforms), disability incompatible with the observed lifestyle
• Fire: doubtful material circumstances, concomitant financial difficulties, recent over-insurance
• Liability: accommodating witnesses, theatrical bodily injury, overstated business interruption

How does the investigation unfold, step by step?

Five stages: written scoping of the insurance question; analysis of the claim file and its inconsistencies; open-source verification; proportionate field observation; a final time-stamped report with exhibits. You remain in control at every stage, budget and duration validated in advance.

1. Scoping. We define the question to be settled, not “investigate Mr X” but “is Mr X carrying on an activity incompatible with the incapacity declared on 12 March?”. A written mandate fixes the scope.

2. File analysis. Declarations, expert reports, the insured’s own photographs: we look for internal inconsistencies before going into the field.

3. Open sources. Social networks, online listings, public registers, local press: our OSINT unit documents what is already visible.

4. Field. Observation from public space, at the relevant times, by experienced investigators, never intrusion or provocation.

5. Report. Chronology, dated findings, time-stamped photographs, sources: a single signed document, ready for contradictory expert proceedings or litigation.

Sick leave and disability: how far can checks legally go?

Observation is lawful as long as it takes place in public space, without unfair stratagem, and remains proportionate to the stakes of the file. French courts regularly admit private investigators’ reports that respect this framework, and exclude those that overstep it.

The ridge line is well known: the insured’s private life is protected, but an insurance contract binds him to sincerity, and the Court of Cassation accepts that insurers may prove fraud by any fair means. In practice: watching someone load bags of cement in a car park open to the public is admissible; filming him at home over the hedge is not.

We decline mandates that would require crossing that line, which protects you: a single unfair exhibit can get an entire report excluded and weaken the company’s position.

What does the fraudster actually risk?

Nullity of the policy with premiums retained by the insurer (art. L113-8), restitution of indemnities already paid, and criminal prosecution for deception or attempt, up to five years’ imprisonment and a €375,000 fine (arts. 313-1 and 313-3 of the Criminal Code).

Proven fraud shifts the balance of power: the company is no longer paying under threat of litigation but choosing, refusal of cover, settlement, complaint. The report also serves internally: it objectifies the decision against the insured’s appeals, before the mediator or the court, and feeds the market’s prevention mechanisms.

Conversely, when our findings corroborate the declaration, the file settles quickly and cleanly: half the value of an investigation is extinguishing false suspicions. Over time, that discipline also protects the portfolio: word travels fast among organised fraudsters about which insurers verify and which pay on trust.

Three typical cases, anonymised

A water-damage claim padded with furniture the insured never owned, exposed by his own sale listings; a road-accident victim “unable to drive” filmed at the wheel every morning; a tradesman on full sick leave found on his own building sites through his professional posts.

The phantom furniture. After water damage, an insured declares the loss of high-end furniture. Open-source checks turn up his own sale listings, pre-dating the loss, proving the items had left the flat long before. The indemnity is brought back to the actual loss.

The driver who could no longer drive. An accident victim claims heavy damages for being unable to drive. Four mornings of observation from the public highway are enough: daily trips at the wheel, loading, errands. The contradictory expert appraisal revises the loss, our report as the key exhibit.

The tradesman on full leave. A tradesman compensated for total incapacity in fact carries on his business. His own professional posts, cross-checked by two site visits, document ongoing works. The insurer suspends benefits and files a complaint.

Why do claims departments work with Prometheus?

Because an insurance file forgives no approximation: CNAPS licence, fair methods tested in litigation, professional secrecy, reports in a constant format, short lead times across the Paris region and degressive pricing from €85/hour (excl. VAT) for regular flows.

Our investigators have worked for years with fraud inspectors, experts and insurers’ counsel: they know what a report must contain, and what it must never contain. Every assignment is handled by a single directly reachable contact, from scoping to delivery. See also our Insurers hub and our financial enquiries.

How much does it cost?

Our assignments start at €85/hour (excl. VAT) (full day €850, volume discounts). Every case gets a free written quote before any commitment, no hidden fees.

Most fraud verifications take 10 to 30 hours of investigation depending on the set-up; beyond 20 hours the rate becomes degressive (€80, then €75 and €70/hour excl. VAT). A systematic checkpoint precedes any overrun, so the budget never drifts silently.

See the full price list.

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