Hello there, Please find the below picture for the questions to answer. The word
ID: 2601516 • Letter: H
Question
Hello there,Please find the below picture for the questions to answer. The word limit is 500words so please devide on to the number of questions, you may for example use more words in one questions than the other which is fine. As long as it 500 words in total to answer all the questions. Not 500 words for each question.
Hello there,
Please find the below picture for the questions to answer. The word limit is 500words so please devide on to the number of questions, you may for example use more words in one questions than the other which is fine. As long as it 500 words in total to answer all the questions. Not 500 words for each question.
: ,Ica . t -||TNorm al-I No Spac-Heading 1 Heading 2 Title Font Paragraph Styles Area 3- Insurance Fraud What are the key areas of insurance fraud throughout the insurance lifestyle? Can you use relevant examples to support your understanding of these areas? What "red flags" may cause an insurer to be suspicious that the policyholders claim is fraudulent? Are "red flags" sufficient in themselves to identify fraud? What about if there are multiple red flags? Are you clear about the steps insurers have taken to discourage and mitigate the r policyholder fraud? how effective do you consider these to be? 1. 2. 3. 4. iskof 5.
Explanation / Answer
Insurance industry estimates generally put fraud at about 10 percent of the property/casualty insurance industry’s incurred losses and loss adjustment expenses each year.
Q.1 and Common frauds include "padding," or inflating actual claims; misrepresenting facts on an insurance application; submitting claims for injuries or damage that never occurred, services never rendered or equipment never delivered; and "staging" accidents.
Q.2 Examples of insurance frauds :
• In the UK, a man faked his own death by drowning. He was traced to Panama, where he was living with his wife off the proceeds of his life insurance policy. Both were convicted and served several years in prison.
• In Slovenia, three individuals took out several life and injury insurance policies each before travelling to Canada on holiday. While there, they allegedly sustained personal injuries in a car accident and claimed for their injuries under their policies. It was later discovered that all three had made insurance claims for other accidents during the period of injury. Criminal and civil charges were brought and the individuals were made to pay all the costs of investigating the fraud and to repay the sums already paid out under the insurance policies.
Q.3 Red flags : Analyze claim history : Insurers also try to discern any patterns in your past claims regarding their frequency and type. You may not realize it, but insurance companies keep in-depth records on claims and do all sorts of analyses to interpret the data they contain -- everything from figuring out who is most likely to file a claim to when and where. If your claim doesn't match the typical pattern, they'll notice the differences and suspect a fraud.
Check list of suspicious loss indicators : Few examples are
Use sophisticated computer systems to detect fraud : Fraud often occurs through billing, and quite often for medical claims. Physicians or clinics may bill insurance companies for services never rendered, for example, or for procedures or services that weren't medically necessary. Or they may jack up the cost of certain services, charge more than once for the same service or "unbundle" claims -- billing, say, for three separate surgeries on a patient whose three toes were operated on at the same time. Complex computer systems have been developed to tease out suspicious bills and billing patterns from physicians and medical establishments
Evaluate prospective employees credit history : Insurance fraud isn't limited to external sources. There's a certain amount of it that originates with insurance companies' own staffs. Claims adjustors cut a lot of checks, and unethical folks may try to skim a few bucks off the top. Agents can commit fraud by "stealing" customers' car insurance or life insurance premiums. The agents take in customers' money, then pocket it without ever actually purchasing the policies. Savvy insurance companies try to prevent such fraud by running credit checks on all prospective employees. Applications from those with bad credit or financial issues are flagged as those more likely to commit fraud
Q.4 Red flags are not sufficient in themselves.there should be proper monitoring and control over issues marked as red.
Q.5 Steps taken by insurers to discourage frauds :
Insurers take action against those that commit fraud. The consequences can include:
• non-payment of claims
cancellation of the insurance policy
the insurer seeking costs incurred (for example for experts in assessing the claim)
• subsequently being unable to obtain insurance and other financial services
• reporting of the case to the police for further investigation
• prosecution and a custodial sentence
• a criminal record
Steps taken by Insurance industry to combat fraud : The insurance industry’s responses to fraud vary between countries and the initiatives are wide-ranging. For instance:
a.• In several countries, insurers exchange relevant information to help them identify potential frauds. Insurers are transparent about this and operate in compliance with data protection and privacy requirements.
b.Cross-border cooperation also exists. For example, the Nordic countries meet regularly to discuss trends, issues and common challenges, since trends in one country have been seen to spread to neighbouring countries.
c.In several countries, including France, Sweden and the UK, insurance companies have set up (more or less) formalised groups to investigate insurance fraud.
d.Insurers have also increased their co-operation with law enforcement agencies in several countries.
e.Insurers increasingly use technology to uncover fraud. Methods include electronic devices to detect the authenticity of documents submitted in support of claims and the use of publicly available information on various social media and other websites.
• In Sweden, insurance undertakings use advanced key-readers to confirm that car keys submitted in support of a claim for a stolen vehicle are those belonging to the car alleged to have been stolen.
• In the UK, a claim for alleged back injuries was rejected when Facebook images showed the claimant performing gymnastics and training for a charity run.
f.Training of insurance staff and police is widely used to raise awareness of fraud, to show how to detect it and to highlight the new and ever-changing methods used by fraudsters.
g.The use of “cheat-lines” is successful in several countries, including Ireland, Sweden and the UK. Members of the public can call a helpline to report suspected or known insurance fraud. The caller will generally retain anonymity to encourage such reporting.
The insurance industry continues to strengthen its systems and controls to ensure that all types of fraud are detected and prevented — whether committed at the application or the claims stage — to minimise the cost of fraud to insurers and therefore the impact on honest customers. Insurers’ methods are constantly evolving to combat changes in fraudster behaviour.
Note: I TRIED TO BE VERY PRECISE WITH MY ANSWER AS YOU MENTIONED THE WORD LIMIT TO BE 500.
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