Insurance fraud : causes, characteristics and prevention

摘要

Although there is a growing volume of research on various kinds of fraud,\udrelatively little has been written about insurance fraud. Even fewer studies have\udbeen undertaken on the prevention of insurance fraud. This study aims to fill this\udgap. It focuses not on large-scale corporate fraud but on individuals ‘fiddling’\udtheir home, motor and travel policies.\udDuring the course of this study, the researcher surveyed the public and found that\udinsurance fraud is commonplace, and committed by people of different classes—\udoften unwittingly, and rarely with much regret. Insurance companies were\udsurveyed, and data collected by interviews with insurance staff. It emerged that\udmany insurers did not realise they had an insurance fraud problem, and those that\uddid were either doing little to prevent it or were using ineffective methods.\udInsurance fraudsters are often given a great deal of help, often by officials who\udabuse the trust placed in them; insurers’ relationship with the police and with loss\udadjusters is not geared to stopping fraudsters, and insurance fraud is thus rendered\udeasier. To illustrate this, and with the help of an insurance company, the researcher\udconducted a mock insurance fraud, and found it easy to commit.\udThis study shows that insurance fraud is mostly an opportunistic crime. Within the\udstudy of crime prevention there is an approach which seeks to reduce the number\udof offences by curtailing the opportunities for crime. This is known as ‘situational\udcrime prevention’, and is based on the ‘rational choice perspective’. Professor Ron\udClarke, whose name is most closely associated with the approach, has called for\udmore research to apply the principles and techniques of opportunity reduction to a\udrange of crime types. This thesis represents an attempt to do this in relation to\udinsurance fraud, and in so doing to stimulate ideas on how insurance fraud can be\udtackled effectively. In addition, it offers a new perspective on the situational\udapproach and the techniques of opportunity reduction, plus a revised classification\udof these techniques. At the same time it offers a critique of the situational\udapproach itself. The findings suggest that if fraud within the insurance industry is\udto be taken seriously then there are a range of structural concerns that need to be\udtackled, and that this moves beyond the scope of situational prevention.