life insurance fraud
199582791
Fraud Detection in Medical Insurance Claim with Privacy Preserving Data Publishing in TLS N Using Blockchain
Insurance fraud is one of the most serious problem that insurers, consumers and regulators witnessed in the last couple of years affecting availability of insurances. Increase in the cost of the companies, inflated premium is caused by the number of frauds in the medical insurance sector threatening the viability of the insurance companies and also an adverse effect on the profit they incur. Forged documents submitted for claim settlement gets verified due to limited resource availability. Enabling TLS N in the conversation between the insurance company, policy holder and medical institution curtail life insurance frauds. Data privacy must be given utmost importance while we handle medical insurance scenarios, TLS N with privacy preserving data publishing schemes facilitates privacy and mitigates content hiding attack. These records stored in blockchain keeps track of the policy details, the medical reports and insurance claims over the period of validity, helps detecting fraud in the insurance claim.
Thanusree Mohan Kanakkath Praveen
168250008
The significance of physical surveillance as a method in the investigation of insurance fraud: a Discovery Life perspective
Ben Visser
169265983
Impact of Claims Management on the Profitability of Nigerian Insurance Company: An Empirical Study of the Non Life Insurance Sector
Claim is the largest expenses of an insurance company. Therefore, claims management is seen as an essential tool of image boosting in insurance industry. Excellence in claims handling gives an insurance company a competitive edge over its competitors. For an insurance company, claims processing is one of its core activities. It could be said to be the main reason why insurance companies are established. Managing it more effectively and efficiently, aligning it with corporate business objectives, and achieving real time operational awareness are high priorities of an insurance company. This is because claims processing touches all part of the organization, affecting competitive positioning, customer service, fraud management, risk exposure, cost control and Information Technology infrastructure. The objective of this research therefore, is to empirically investigate the impact of claims management on the profitability of non life insurance companies in the Nigeria insurance industry. Hypotheses were tested to find out whether claims management is significantly related to profitability of non life insurance companies in Nigeria. The study adopts longitudinal design which follow the same sample over time and make repeated observations; hypotheses were tested using correlation analysis. The study revealed that there is a significant relationship between claims management and the operating cost of non life insurance companies in Nigeria. However, the study revealed that there is no significant relationship between claims management and profitability of non life insurance companies in Nigeria. It is recommended that the claims management department should be properly structured with highly technical, trained and experience staff so as to manage the claims of insurance companies properly as a well managed claim lead to profitability through repeated purchase.
Micheal Ogunnubi
52010328
Please be Honest and Provide Evidence: Deterrents of Deception in an Online Insurance Fraud Context
Summary The present experiment examined whether people could be deterred from lying in an online insurance claim setting. A total of 96 participants were asked to submit a theft insurance claim. Reflecting real life, submitting a claim that went beyond the actual costs of the stolen items was associated with advantages and disadvantages. Two deterrence factors were introduced: asking claimants to provide evidence that they actually owned the stolen items (Evidence Instruction, often used by insurers) and asking participants to read out before starting to submit the claim that they will be truthful (Honesty Statement, not often used by insurers) We also examined at what stage of the interview claimants embedded their lies in their otherwise truthful stories. The honesty statement but not the evidence instruction made claimants more honest, and participants lied more as the interview progressed. (c) 2016 The Authors Applied Cognitive Psychology Published by John Wiley Sons Ltd.
Applied cognitive psychology
Sharon Leal Aldert Vrij Galit Nahari Samantha Mann
159707948
Law Aspects and Trends for Life Insurance in the Republic of Macedonia
Possibilities for insurance development in the Republic of Macedonia are growing through the time. Insurance is multidisciplinary phenomenon and can be analyze from economic, actuary and law aspect. The aim of the paper is to analyze law aspects for development of insurance, with particular accent of life insurance, as a main pillar for insurance development. Law regulation of life insurance is in accordance with EU and world standards and it gives possibilities for further development. With analyzing parameters, it can be concluded that numbers, percentages of life insurance in total insurance are increased every year. This trend should be used from different subjects affected by insurance. Also different laws, its implication, implementation and criminal prevention of insurance fraud, will be analyzed in the paper with appropriate methodological instruments. All that should be done in order to extract useful conclusions and recommendations for future development of the sector. Keywords: insurance law, life insurance, development, economic growth
Risto Rechkoski
168477169
An Empirical Analysis of the Characteristics and Detection of Life Insurance Frauds
The mounting frequency of life insurance frauds is driving up costs of insurance companies and premiums of policyholders. Investigations were carried out to assess the fraud scenario in the Indian life insurance companies, the potential risk exposure, the impact of growing events of frauds, and company's practices to counteract the frauds. This study examines the factors which aid in implementing an effective fraud control policy and also whether insurers' artillery against life insurance frauds is used effectively. Numerous variables are tested such as characteristics of perpetrators (fraudsters) schemes employed for insurance frauds, and types of detection and investigation techniques used for comparison of the characteristics of insurer fraud with those of insurance fraud. A detailed survey of 50 employees of different life insurance companies provides the database; techniques such as chi square statistics, paired sample T test, cross tabulation, frequency distribution were used to measure test of independence, test of significant differences and occurrence of events.
Dhara Shah
157420569
Murder for Life Insurance Money: Protecting the Children
Children are being murdered for life insurance proceeds. Of course, if a beneficiary murders a child for the recovery of life insurance money and if he is apprehended, he will surely face numerous legal consequences. He will not recover the insurance money, he will be prosecuted and likely sentenced to lfe imprisonment or execution, he may be sued for the wrongful death of the child and he may be prosecuted for insurance fraud. However, all of these legal responses are triggered by the death of the child and, therefore, do not serve to protect the child from being murdered in the first instance. On the other hand, there are legal doctrines in place that would appear to be directed toward protecting a child from being the target of a murderous beneficiary, most notably the insurable interest doctrine. t Associate Professor, Campbell University School of Law. The author would like to thank Megan Greene, Michael Dunn, and Johnathon Naylor for their research assistance.
Johnny C Chriscoe
168974143
The fight against fraud in life assurance a lacuna in the insurance industry
Maria A Muscat
28813916
Fraud detection using outlier predictor in health insurance data
In day today life, health insurance data collection plays major role for employers. In several countries misbehavior in health insurance is a major problem. Health insurance data fraud is an intentional act of misleading, hiding or misrepresenting information that makes profit to a single or group of members. These kind of violation leads to major loss for health insurance providing organisation. Hence Detecting fraudulent and abusive cases in health insurance is one of the most challenging problems. The aim of the project is fraud detection in health insurance data. In order to increase the accuracy of the framework, several methods are utilized, such as the pairwise comparison method of analytic hierarchical processing (AHP) Its mainly focus on a concrete problem of probabilistic outlier detection. Overcoming the existing drawback of time consuming, proactive and retrospective analysis are integrated together, which significantly reduces the time requirements for the fact finding process.
2017 International Conference on Information Communication and Embedded Systems (ICICES)
M Anbarasi S Dhivya
201613721
Fraud Detection in Automobile Insurance using a Data Mining Based Approach
nsurance industry is one of the most important issues in both economy and human being life in modern societies which awards peace and safety to the people by compensating the financial risk of detriments and losses. This industry, like others, requires to choose some strategies to obtain desired ranking and remain in competitive market. One of efficient factors which affects enormous decision makings in insurance is paying attention to important information of customers and bazar that each insurance company stores it in its own database. But with daily increasing data in databases, although hidden knowledge and pattern discovery using usual statistical methods is not impossible, it is so complicated and time consuming. In this paper we employ data mining as a powerful approach for extracting hidden knowledge and patterns on massive data to guide insurance industry. For example, one of the greatest deleterious challenges here is interacting between insurance companies and policyholders which creates a feasible situation for fraudulent claims. Due to importance of this issue, after investigating different ways of fraudulent crimes in insurance, we use K Means clustering technique to find fraud patterns in automobile insurance include body and third party. Our experimental results indicate a high accuracy when have been compared with statistical information extracted from data sets. Outcomes show significant relations among efficient factors in similar fraud cases.
Ali Ghorbani Sara Farzai