1Anti Fraud Regulation for the insurance companies

Regulations. 3 W رة ا(آت ااردة : ه%$ ا#"! 8آت ا وإ دة ا و8آت ا, ا!ة وYء ا، وآ# ء ا وYء إ  دة ا، ووآ# ء إ دة ا أ  ارات اZ : ه%$ ا#"! 4L[ ا4 ااردة : ادة ا5و  ا#"! اL%3 Iم ا 8آت ا او4  ا  ا اديSaudi Arabian Monetary Agency إدارة ا اInsurance Supervision Department Insurance fraud is defined1 as an act or omission of an act intended to gain dishonest or unlawful advantage for the party committing the fraud or for other parties. This may, for example, be achieved by means of: اBAل : 8آت ا ه ا م أو اB ع  ا م 3 إ آ1 .ة \ 4.3, أو \ (و  W] اYف ا%ي 3)G1 <3 اBAل أو W] أ_اف أKى و3G ,%$ اا أن )!W'  ' ا`ل  _3a a) Misappropriating assets. ا ةءإ Wّف cل b) Deliberately misrepresenting, concealing, suppressing or not disclosing one or more material facts relevant to a financial decision, transaction or perception of the insurer’s status. F3!)  F(G، إKLء، > أو م ا a )Wّر و)Wd  إAى ا"> اد3 أو أآ` ا  ار  أو  أو )Wّر e> 8آ ا c) Abusing authority, a position of trust or a fiduciary relationship.  اf#ل ا Y ، > g  أو # ا"4 Scope and Exemptions ا:'ق وا>%:ءات This Code applies to insurance and reinsurance companies, and insurance related service providers including insurance brokerages, insurance agencies, reinsurance brokerages, and reinsurance agencies. )Ya أAGم ه%$ ا#"!  8آت ا وإ دة ا و8آت ا, ا!ة وYء ا، وآ# ء ا وYء إ دة ا، ووآ# ء إ دة ا Companies can be subjected to multiple forms of fraudulent activities from inside or outside the company. However, most of these activities fall under three overarching categories: > ) 3G أن ا(آت e! أ8Gل دة  اBAل  داK' ا(آ أ وKر<, إB أن \ ه%$ ا(_ت )رج : إ_ر g#ث :hت آى a) Internal fraud: fraud perpetrated by a company’s employee. KاBAل اا وه اBAل ا%ي 3)GE kF : ا(آ b) Intermediary fraud: fraud by insurance service providers against the companies or policyholders. '  اBAل ارس 8آت ا, ا!ة وه اBAل ا%ي 3)GE وآ#ء ووYء ا e ا(آت أو ا ,d c) Policyholder fraud: fraud committed in the purchase or execution of an insurance product to obtain an illegitimate coverage or payment.  '  اBAل ارس ا ,d وه اBAل ا%ي 3d ار)G E : 8اء أو )L% m  2ت ا !Wل  )fY أو د: \ (و  1 Source: IAIS guidance paper on preventing, detecting and remedying fraud in insurance, October 1- 0!#- /.- #- ,!'& $#" )( + *)#( '& !% $#" !