Search results

The purpose of this paper is to investigate the insurance market in which moral hazard and insurance fraud coexist. In this situation, this research examines the relationship between moral hazard and insurance fraud. Also, this research shows how the amount of policyholder's effort to lower accident probability changes when insurance firm increases their investment in preventing insurance fraud.

Using a theoretical model containing five‐stages, the author sheds light on how the possibility of insurance fraud affects the amount of policyholder's effort.

The main results of this research are as follows. First, the amount of policyholder's effort is a weakly monotone decreasing function of the insurance firm's investment in preventing insurance fraud. Second, unlike in previous moral hazard models, the policyholder chooses a strictly positive amount of effort even in the full insurance case because the possibility of insurance fraud gives an incentive to realize policyholder's effort. Third, the amount of insurance firm's investment in preventing insurance fraud depends on whether it wants to give an additional incentive to policyholder's effort in exchange for realizing the possibility of insurance fraud.

This is the first paper to investigate the relationship between moral hazard and insurance fraud by using the microeconomic theory.

Insurance frauds deeply affect insurance companies, policyholders, and the insurance industry as a whole. The cost of fraudulent damage affects the profitability of companies, and has negative effects on the society in terms of moral values. Increases in insurance costs can lead to increases in the premiums paid by policyholders, each family, and, ultimately, all of the insured. Recently, new legal regulations related to this issue have been performed in Turkey and higher institutions have been created. A regulation issued by the Under-secretariat of the Treasury, on June 1, 2011, defines insurance fraud as aggravated fraud. Insurance fraud in Turkey usually takes the form of intentional misrepresentations of facts to the insurance company to get the company to pay for something not actually covered by the policy. Studies examined the insurance industry in terms of the concept of financial crime, and inclusion of the concept of financial crime in insurance regulations was proposed since financial crimes have an important place in the current problems of the industry. In addition, it is seen that insurance frauds have changed over time as a result of studies.

Introduction: The insurance sector is playing a crucial role in the sustainable growth of the Indian economy. But in India, this sector loses crores of rupees every year due to the increasing fraud cases. With the increase in insurance customers, insurance companies need to efficiently equip themselves with a robust system to handle claims fraud. Detection of insurance fraud is a pretty challenging problem. Nowadays, machine learning (ML) and artificial intelligence (AI) are the strategic choices of many leading organisations that want to proceed in a new digital arena.

Purpose: This chapter’s main objective is to highlight the fundamental market forces driving the adoption of AI and ML and showcase the traditional and modern methods to predict insurance claims fraud intelligently.

Methodology: Various research papers have been reviewed, and ML methods have been discussed, which are all being used to predict insurance fraud claims. This chapter also highlights various driving forces influencing the adoption of ML.

Findings: This study highlights the introduction of blockchain technology in fraud detection and in combatting insurance fraud. Literature indicates that the quantity and quality of data significantly impact predictive accuracy. ML models are beneficial to identify the majority of fraudulent cases with reasonable precision. Insurance companies should explore the benefits of experienced resource persons from the same domain and develop unique business ideas/rules.

The purpose of this paper is to investigate how cultural tightness may influence consumers’ attitudes toward insurance services and occurrence of insurance fraud.

Drawing on Gelfand et al.’s (2011) theory of tight and loose cultures, the authors theorize that perceived wrongness of insurance fraud, fraud occurrence and perceived risk of being caught depend on the cultural tightness. Using field data from a global European social survey (ESS), the authors investigate these differences across two fairly different European countries – Norway (i.e. tight culture) and Ukraine (i.e. loose culture).

Consumers from tight culture report less tolerance for insurance fraud (inflating insurance claim) are less likely to commit an insurance fraud, and they perceive higher level of risk of being caught than their counterparts from loose culture (Ukraine).

Understanding cultural variability in attitude toward insurance fraud, the occurrence of insurance fraud and the sensitivity to the risk of being caught could enrich the authors knowledge about how to prevent insurance fraud.

Consumer protection agencies, consumer educators and policymakers could all benefit from understanding cultural variability in attitude toward fraud. This will potentially help to design effective learning and education programs to sensitize customers to the illegal and unethical aspects of fraudulent behaviors.

Insurance fraud is a universal issue and exists in many European countries, yet no previous work has investigated the effect of cultural tightness–looseness on fraud perception.

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.

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.

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.

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.

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.

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

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.

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.

The insurance industry both in the UK and abroad uses a variety of measures to counter fraud. This short paper, as well as examining these measures, will report on the apparent success the industry is having against fraudsters in the UK. In addition to this some of the more noteworthy cases will be reported upon in order to inform the reader of the differing types of frauds which may be encountered.

Insurance fraud as a global economic problem threatens the financial strength of insurers and threatens the survival of the insurance institution. The purpose of this paper is to explore the magnitude of the problem including the industry's and regulatory authority's responses in tackling the menace in Nigeria. The paper is motivated by the recent effort on the part of the Nigerian regulatory authority to strengthen the sector through consolidation. Such renewed vigour on part of Nigeria is geared towards fighting all forms of economic crimes in both public and private sectors in post‐military years.

The paper reviews the literature on the existing fraud control mechanisms, i.e. insurance contract design and auditing and the perception of fraud by customers in the insurance market. A survey is conducted by interview method to explore the size of the problem and the effectiveness of the approach the industry and its regulator are adopting to control it.

The paper's findings suggest a lukewarm or no serious attitude on the part of the regulatory authority and the insurance companies in appreciating the enormity of the problem now and in the future. This stems from lack of clear‐cut sanctions for offenders and mechanism for enforcement.

The paper reveals the paucity of research of such a topical issue in developing economies and suggests the need for urgent stakeholders' summit that will discuss effects of insurance fraud on the industry with a view to identifying specific roles and responsibilities of each stakeholder group in tackling the problem. This should also be complimented with the establishment of insurance fraud bureau that would promote public awareness campaign on the evil effect of fraud on the economy.

This paper aims to measure the extent of effects of insurance fraud on the financial performance of insurance companies in Ghana. It also examines the causes and stringent measures that can be used to fight against insurance fraud.

Primary and secondary data obtained from 39 insurers in Ghana are used in this paper. A multiple regression model is used to determine the relationship between financial performance and insurance fraud variables.

The results from the model indicate that statistically insurance fraud has a significant negative effect on the annual return on assets (financial performance) of insurers in Ghana. Also, weak internal controls, poor remuneration of employees, falsified documents, deliberate acts of policyholders to profit from the insurance contract and inadequate training for independent brokers are found to be the major causes of insurance fraud in Ghana. To deter insurance fraud, effective internal fraud policy, rigorous assessment of insurance policies and claims, adequate training for independent brokers on insurance fraud and modern information technology tools are paramount in fighting this menace in Ghana.

These findings are to have substantial impact on the techniques insurance companies will develop to fight insurance fraud and the policies that will be developed by governments and national insurance regulatory bodies to fight this menace.

The main value of this paper is the determination of the key variables that constitute insurance fraud and their impacts on the annual financial performance of insurance companies in Ghana.

The purpose of this paper is to survey the automobile insurance fraud detection literature in the past 31 years (1990–2021) and present a research agenda that addresses the challenges and opportunities artificial intelligence and machine learning bring to car insurance fraud detection.

Content analysis methodology is used to analyze 46 peer-reviewed academic papers from 31 journals plus eight conference proceedings to identify their research themes and detect trends and changes in the automobile insurance fraud detection literature according to content characteristics.

This study found that automobile insurance fraud detection is going through a transformation, where traditional statistics-based detection methods are replaced by data mining- and artificial intelligence-based approaches. In this study, it was also noticed that cost-sensitive and hybrid approaches are the up-and-coming avenues for further research.

This paper’s findings not only highlight the rise and benefits of data mining- and artificial intelligence-based automobile insurance fraud detection but also highlight the deficiencies observable in this field such as the lack of cost-sensitive approaches or the absence of reliable data sets.

This paper offers greater insight into how artificial intelligence and data mining challenges traditional automobile insurance fraud detection models and addresses the need to develop new cost-sensitive fraud detection methods that identify new real-world data sets.