Tag Archives: Insurance Fraud

I.I.I.’S CEO TESTIFIES BEFORE CONGRESS ON TECHNOLOGICAL INNOVATION IN THE FIGHT AGAINST INSURANCE FRAUD

Sean Kevelighan, the I.I.I.’s chief executive officer told a U.S. Senate Subcommittee in Washington, D.C., today that U.S. auto, home and business insurers pay an estimated $30 billion annually —nearly 10 percent of their total claim payouts—in fraudulent auto, home, and business insurance claims. To combat fraud insurers are increasingly turning to vendors who offer technological innovations stemming from big data and artificial intelligence. These vendors are allowing insurers to assess prospective customers, verify claims and identify suspicious activity in ways that were not previously possible.

In a report released last month, the Boston-based Aite (pronounced EYE-TAY) Group outlined the fact that insurers are recognizing their fraud-fighting efforts must adapt to this new era, and found reason for optimism. The Aite Group reports insurers are retaining state-of-the-art vendors, like data aggregators, producers, and receivers and then analyzing this data through the use of artificial intelligence and predictive analytics. The result? Insurance companies are equipping themselves with the high-tech tools they need to assess a prospective customer, verify a claim, and identify suspicious activity.

Click here for the full testimony.

To Lie Or Not To Lie

Have you ever wondered how far people will go to stretch the truth in order to save a few bucks?

Research out of the United Kingdom by global insurer Zurich sheds light on this behavior.

In a poll of 2,000 adults in the UK, one-in-five (20 percent) admit to lying to their insurance company, despite a separate 82 percent knowing that wrong information registered on an insurance form can render the policy invalid.

Why do people lie to their insurer? The reasons are varied:

– 29.3 percent lie because they are unsure of the correct information or didn’t understand the process to begin with;
– 10 percent knowingly lie because they are scared of the consequences of being totally truthful;
– 8 percent even admit to lying as they don’t take the process seriously.

Despite these numbers, the poll also revealed 87 percent of people would not lie to an official body, such as the police or their accountant, in order to save money.

In the words of Zurich home insurance expert, Phil Ost:

It’s really encouraging that most people don’t feel it’s acceptable to lie to save money and honesty really is the best policy when it comes to things like jobs and insurance. The consequences of being found out can be severe and maybe invalidate a policy and potentially result in claims not being paid.”

Maybe insurers should take note that 32 percent of Brits are more comfortable lying online than over the phone, while 34 percent will lie to put a positive spin on a bad situation, and another 10 percent will lie about their weight.

Dr Patrick Fagan, Lecturer in Consumer Behavior, Goldsmiths University, sums it up best:

People lie about all sorts of things — from their weight to their employment experience — but the ‘white’ lie is still the most prevalent…it’s interesting to see that there are still a sizeable group of people who’d be dishonest in more serious and formal situations.”

More on this story from Post Magazine.

Check out I.I.I. facts and statistics on insurance fraud.

Insurance Fraud Has Greater Impact Than Previously Estimated

It’s been commonly understood that insurance fraud accounts for up to 10 percent of property/casualty insurance industry losses, but a new survey of U.S. insurers indicates that fraud may be much more prevalent.

Some 45 percent of insurers responding to the FICO and Property Casualty Insurers Association of America (PCI) survey estimated that insurance fraud costs represent 5-10 percent of their claims volume, while 32 percent said the ratio is as high as 20 percent.

The survey also found that more than half (54 percent) of insurers expect to see an increase in the cost of fraud this year on personal insurance lines, while less than three percent of insurers expect to see a decline in the cost of fraud on personal lines.

Insurers responding to the survey said they expect the most significant increase in the cost of fraud will affect personal property, workers’ compensation and auto insurance. The majority (61 percent) attribute the increases in fraud to sustained economic hardship by policyholders.

While only 17 percent of insurers attributed the expected increase in fraud to a rise in the sophistication of criminal gangs, 60 percent expect a rise in workers compensation fraud rings, and 61 percent expect a rise in auto fraud rings.

The survey also found that 76 percent of insurers believe there is increased risk of fraud in no-fault states compared to states with tort systems.

When asked about fraud-fighting initiatives that can have the greatest impact on insurance fraud, predictive analytics was identified as the most effective by 45 percent of respondents.

Insurers also included the use of anti-fraud teams for specific books of business (37 percent), link analysis for detecting fraud (31 percent), business rules for stopping known fraud types (29 percent), and external databases (29 percent) as other useful approaches to fight fraud.

In a press release, Russ Schreiber, who leads FICO’s insurance practice, says:

The insurance fraud problem is estimated to exceed $40 billion globally and is showing no signs of abatement. The findings of the FICO PCI Insurance Survey demonstrate that insurers recognize the problem and are looking to improve ways to detect and prevent fraud earlier in the claims process.†

Insurance Journal has more on this story.

Check out I.I.I.  facts+statistics on insurance fraud.

Insurance Fraud Hall of Shame

The Coalition Against Insurance Fraud recently released its annual Insurance Fraud Hall of Shame, highlighting America’s most brazen, klutzy or vicious convicted schemers of the year. A murderous agent, a child-poisoning shakedown artist and a bungling home burner are among the seven swindlers elected to the No-Class of 2009. All were convicted or had other legal closure during the past year. According to the Coalition, insurance fraud is an $80 billion-a-year crime, yet its research shows that consumer tolerance for insurance fraud has risen in recent years. Many view fraud as a harmless prank, but these culprits put a human face on insurance fraud. As the Coalition says: “They remind us that fraud is far more than a victimless prank. People suffer, and sometimes die. Families are broken. Children feel pain and cry. Trusting seniors lose their life savings. Everyone’s insurance premiums rise.† Check out I.I.I. information on insurance fraud.