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Article

T. Joji Rao and Krishan K. Pandey

The fact that complaints regarding general insurance claims are three times as numerous as those of life insurance claims suggests that claims behaviour of general…

Abstract

Purpose

The fact that complaints regarding general insurance claims are three times as numerous as those of life insurance claims suggests that claims behaviour of general insurers be investigated to minimize operating losses and ensure operational excellence. This paper seeks to address this issue.

Design/methodology/approach

Study of variance and factor analysis has been undertaken to achieve the objective of identifying factors which govern claims in general insurance business. In order to understand the dependency of claims over the sectors and segments, statistical hypothesis testing along with cross tab analysis has been conducted. The study also evaluates the relationship of these factors over the sectors and segments by running a multiple regression.

Findings

An empirical result of the study proves that there exists an association between type of sectors, i.e. public and private and segments of insurance namely fire, marine and miscellaneous. The study also suggests a claim projection model for the general insurance players.

Research limitations/implications

Exclusion of specialized players due to the reason being new entrants and in order to maintain common parlance of sectors may be a limitation to this study.

Originality/value

The study recommends that insurance players should not treat the claims settlement strategies in isolation of segments. The claims projection model as suggested in the study may prove to be extremely helpful in projecting the claims and in turn reduce the increasing underwriting losses.

Details

The Journal of Risk Finance, vol. 14 no. 3
Type: Research Article
ISSN: 1526-5943

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Article

William C. Lesch and Bruce Byars

The purpose of this paper is to review the management of consumer insurance fraud in the US property‐casualty market, attending to definition, prevalence, insurer and…

Abstract

Purpose

The purpose of this paper is to review the management of consumer insurance fraud in the US property‐casualty market, attending to definition, prevalence, insurer and regulatory responses, and outcomes. A social marketing campaign is offered as a partial, long‐term solution.

Design/methodology/approach

This paper explicates the difficulties associated with defining and measuring consumer insurance fraud, then models the system of factors now in place in redress.

Findings

Little agreement was found for a common definition of consumer insurance fraud and this was explained in part due to the decentralization of insurance regulation, competitive factors, and inconsistency in claims processing. The paper concludes by offering a social marketing campaign as a tool for reducing the incidence and severity of single‐claims fraud, the latter believed to be the largest source of consumer insurance fraud.

Originality/value

This paper affords a macro‐level view of a common and expensive social problem, suggests a practical solution with the promise of reducing long‐term losses at all levels.

Details

Journal of Financial Crime, vol. 15 no. 4
Type: Research Article
ISSN: 1359-0790

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Article

Chupun Gowanit, Natcha Thawesaengskulthai, Peraphon Sophatsathit and Thitivadee Chaiyawat

– The purpose of this paper is to explore the adoption of a mobile insurance claim system (M-insurance) and develops a framework for the adoption of M-insurance by consumers.

Abstract

Purpose

The purpose of this paper is to explore the adoption of a mobile insurance claim system (M-insurance) and develops a framework for the adoption of M-insurance by consumers.

Design/methodology/approach

This study assesses mobile technology for claim management through the lens of the technology acceptance model (TAM) and diffusion of innovation (DOI) models as a major guideline, using exploratory research through in-depth interviews with four executive experts who are first movers in mobile claim motor insurance in Thailand. Semi-structured interviews and open-ended questions were used to conduct group interviews of insurance consumers who mostly use smartphones. The data were collected in a qualitative research approach from Thai insurance consumers (n=177), and contents were classified and analysed to gain strong insights into respondent opinions, comments, attitudes, behaviour, and experiences.

Findings

The results indicate that the external (social) factors influence attitude and behaviour of consumers which link to their intention to adopt M-insurance. These external factors include: preference for face-to-face service; confidence of insurers in accepting claim; and risk of claim knowledge that might cause legal issues among others. In application, the findings shall meaningfully enhance insurer firms’ improvement of adoption rate and development of future features and functions of M-insurance.

Research limitations/implications

This study is based on insurance consumers in each region of Thailand but focuses only on mobile claim management for motor insurance. Although the findings bring new insight and understanding of consumer preferences and behaviours, they were not tested statistically.

Practical implications

The study has practical implications for motor insurance claimants who are concerned over the complicated policy conditions, the perspective risk of claim knowledge and fault admission, and the on-site investigation by surveyor for another party. These are the guidance impediments to overcome M-insurance adoption improvement.

Originality/value

Previously, TAM and DOI approaches have been employed to study general adoption of M-banking by quantitative research which confirmed descriptive data and tested the hypothesis, but neglected crucial data. However, M-insurance is different from M-banking in term of features and functions, purpose and process of usage, and legal liability. Therefore, this study is one of a few empirical studies that attempt to identify insightful factors to consumer uptake of M-insurance which is in its early stage and lacks an underpinning TAM model. This study contributes by identifying insights of “pull” factors to successfully develop M-insurance in Thailand.

Details

International Journal of Bank Marketing, vol. 34 no. 1
Type: Research Article
ISSN: 0265-2323

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Article

Lu-Ming Tseng, Yue-Min Kang and Chi-Erh Chung

The purpose of this paper is to examine the impacts of loss-premium comparisons (loss-premium comparison refers to the amount of an actual loss compared to the premium…

Abstract

Purpose

The purpose of this paper is to examine the impacts of loss-premium comparisons (loss-premium comparison refers to the amount of an actual loss compared to the premium level) and insurance coverage on customer acceptance of insurance claim frauds, based on Adams’ equity theory. Customer perceptions of insurance frauds have been studied in recent years.

Design/methodology/approach

A questionnaire was used as an instrument in the research. The hypotheses were tested using a 3 loss-premium comparisons (the actual loss amount was lower than, or equal to or higher than the annual premium) × 2 insurance coverage (the loss is covered or not covered by the insurance policy) experimental design in a claim application context.

Findings

The results showed that loss-premium comparisons and insurance coverage significantly affect the final claim amounts. According to the results, age and education may relate to customer acceptance of insurance claim frauds.

Originality/value

This study proposed a first empirical investigation into the relationship between loss-premium comparisons and customer ethical decision making in the customer frauds. Insurance coverage is also specifically considered in the study.

Details

Journal of Financial Crime, vol. 21 no. 3
Type: Research Article
ISSN: 1359-0790

Keywords

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Article

Nils Mahlow and Joël Wagner

In view of the fact that claim payouts account for about 70 per cent of annual direct costs in non-life insurance companies and that claims-handling staff sums up to 10-20…

Abstract

Purpose

In view of the fact that claim payouts account for about 70 per cent of annual direct costs in non-life insurance companies and that claims-handling staff sums up to 10-20 per cent of all employees, an optimal claims management environment is of strategic importance. The purpose of this paper is twofold, i.e. on the one hand, the authors introduce a standardized claims management process model and, on the other hand, they apply process benchmarks to various operational parameters.

Design/methodology/approach

The proposed claims management process landscape comprises current industry standards for claims handling from a theoretical perspective, supported by practice insights from the industry. Our model aims to reflect the most important claims processing activities. The claims-handling work flow is structured into five core steps, namely, notification, registration, coverage audit, settlement and closing of the claim. For these core steps, the authors differentiate between three claim complexity categories and their associated back-office levels. In the second part of the paper, the authors assess the industry’s claims-handling efficiency. The authors benchmark industry processes with reference to detailed claims management data from 11 insurers in Germany and Switzerland.

Findings

The benchmarks are based on the previously defined claims management model and are applied separately to the three retail business lines of car, property and liability insurance. We measure claim process times (cycle times) as well as claim quantities and average claim payouts at different levels. Overall, within each business line, more than 30 data points are gathered from each respondent insurer. This allows us to compare the process performance of different insurance companies and to describe significant differences in their process patterns. Furthermore, principal findings are derived from descriptive statistics as well as ad hoc data analyses.

Originality/value

The paper seeks to contribute to the discussion of how different insurance companies perform in claims management and to define best practice. Our findings are relevant to academics and practitioners alike.

Details

The Journal of Risk Finance, vol. 17 no. 2
Type: Research Article
ISSN: 1526-5943

Keywords

Abstract

Details

Rutgers Studies in Accounting Analytics: Audit Analytics in the Financial Industry
Type: Book
ISBN: 978-1-78743-086-0

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Article

Lu-Ming Tseng

The purpose of this paper is to investigate which factors will affect the insurance claims adjusters’ attitude and behavior intention toward lenient claims handling…

Abstract

Purpose

The purpose of this paper is to investigate which factors will affect the insurance claims adjusters’ attitude and behavior intention toward lenient claims handling practices. These factors include organizational justice, behavioral-based control, significant others, and customer complaints.

Design/methodology/approach

Data are collected with questionnaires from full-time licensed insurance claims adjusters in Taiwan. Partial least squares method is used to test the hypotheses.

Findings

The main results show that significant others and organizational justice have significant effects on the claims adjusters’ attitude toward the lenient claims handling practices. Significant others and attitude have significant effects on the behavioral intention.

Originality/value

The influence of claims management on insurance companies’ operation is quite considerable. Poor claims management may not only harm insurance companies’ finance, but also affect the adjustment of future premiums. Yet, in reality, some claims adjusters are found to make flawed claims decisions. Very few studies discuss this problem. This study provides an initial step toward understanding this issue.

Details

Managerial Finance, vol. 43 no. 11
Type: Research Article
ISSN: 0307-4358

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Article

Sabine Gebert-Persson, Mikael Gidhagen, James E. Sallis and Heléne Lundberg

The purpose of this paper is to develop and test a theoretical framework explaining the adoption of online insurance claims characterised by infrequent interactions…

Abstract

Purpose

The purpose of this paper is to develop and test a theoretical framework explaining the adoption of online insurance claims characterised by infrequent interactions, inherent complexity and risk. It extends the technology acceptance model to include knowledge-related and trust-related beliefs.

Design/methodology/approach

The framework is tested with structural equation modelling using data from a survey of 292 customers who made online insurance claims. Findings are further explained through 30 telephone interviews conducted with online and offline claimants.

Findings

Previous research in financial services has shown trust to be equally or more important than perceived usefulness and perceived ease of use in forming attitudes towards adopting online insurance applications. The findings of this paper contradict this by showing, at best, a weak relationship between trusting attitude and intention to use the online service. Trust is somewhat meaningful; however, perceived ease of use, perceived usefulness and technology attitude are substantially more important in an online insurance claims setting.

Research limitations/implications

Contradictory results always beg further research to assure their robustness. Nevertheless, they can also point to a developing trend where trust in the internet channel, per se, is of diminishing importance. Internet and product knowledge are not as pertinent to forming intentions as usefulness and ease of use.

Practical implications

To encourage customers to adopt online applications for a trusted company, all emphasis should be on user friendliness and perceived usefulness of the online interface.

Originality/value

Compared to other channels, consumers are no longer naïve or distrustful of the online channel for interacting with a firm. If they perceive usefulness and ease of use, they will adopt the offered service.

Details

International Journal of Bank Marketing, vol. 37 no. 2
Type: Research Article
ISSN: 0265-2323

Keywords

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Book part

James Boyd

Financial assurance rules, also known as financial responsibility or bonding requirements, foster cost internalization by requiring potential polluters to demonstrate the…

Abstract

Financial assurance rules, also known as financial responsibility or bonding requirements, foster cost internalization by requiring potential polluters to demonstrate the financial resources necessary to compensate for environmental damage that may arise in the future. Accordingly, assurance is an important complement to liability rules, restoration obligations, and other regulatory compliance requirements. The paper reviews the need for assurance, given the prevalence of abandoned environmental obligations, and assesses the implementation of assurance rules in the United States. From the standpoint of both legal effectiveness and economic efficiency, assurance rules can be improved. On the whole, however, cost recovery, deterrence, and enforcement are significantly improved by the presence of existing assurance regulations.

Details

An Introduction to the Law and Economics of Environmental Policy: Issues in Institutional Design
Type: Book
ISBN: 978-0-76230-888-0

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Article

Lu‐Ming Tseng and Wen‐Pin Su

The idea of customer orientation is widely recognized by service people. However, there has been a lack of investigation into how the recognition of customer orientation…

Abstract

Purpose

The idea of customer orientation is widely recognized by service people. However, there has been a lack of investigation into how the recognition of customer orientation may affect the service people's attitudes toward customer misconducts. As a result, our knowledge about the potential impacts of customer orientation philosophy on the ethical decisions made by service people could be insufficient. Hence, by using the life insurance salespeople in Taiwan as an example, the purpose of this paper is to investigate service people's tolerance of two types of customer misconduct (opportunistic frauds and planned frauds) and how those service people would react to the customer misconduct based on their marketing philosophy (customer orientation), perceived fraud size and perceived social consensus.

Design/methodology/approach

The sample of this study comes from life insurance companies in Taiwan. Questionnaires have been used as a data gathering instrument.

Findings

The results showed that customer orientation of the responders is negatively associated with the responders’ tolerance of the customer claim frauds. The responders’ unethical decision is most significantly influenced by perceived fraud size and social consensus.

Originality/value

The duties of insurance salespeople include helping customers settle insurance claims. However, insurance salespeople's tolerance of customer claim frauds is less mentioned in the insurance literature. Few studies have examined the relationship among customer orientation, social consensus and insurance salespeople's tolerance of customer claim frauds.

Details

International Journal of Bank Marketing, vol. 31 no. 1
Type: Research Article
ISSN: 0265-2323

Keywords

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