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Insurance Fraud Prevention
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Flashcards
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False Claims
Submitting claims for injuries or damages that never occurred. Prevention includes investing in fraud detection software, training claims handlers to spot fraudulent behavior, and reporting suspicious activity.
Inflated Claims
Artificially increasing the value of a legitimate claim. Prevention involves thorough documentation review, requiring detailed proof of loss, and using independent adjusters when necessary.
Eligibility Fraud
Applying for insurance coverage under false pretenses or misrepresenting facts to meet eligibility requirements. Prevention can include stricter verification processes, cross-checking with other databases, and identity verification measures.
Application Fraud
Providing false information on the insurance application to obtain coverage or a lower premium. Implement application audits, use data analytics to flag discrepancies, and conduct background checks to prevent this.
Agent Fraud
Insurance agents manipulating customer information for personal gain. To prevent, insurance companies should audit agent behavior, enforce ethical training, and provide whistleblower support systems.
Premium Diversion
Embezzling insurance premiums instead of sending them to the insurer. Implementing strict financial controls, conducting regular audits, and using secure payment systems can help prevent this.
Policyholder Fraud
Policyholders faking an incident or damage for insurance payout. Steps to prevent this include educating policyholders about fraud, requiring incident verification, and thoroughly investigating claims.
Stolen Identity
Using another person's identity to make illegal insurance claims. Prevention methods include implementing strong authentication processes, monitoring for suspicious activities, and using anti-fraud technology.
Vehicle Insurance Fraud
Staging accidents or exaggerating vehicle damages to file insurance claims. This can be prevented by requiring police reports, closely inspecting vehicle damage, and installing in-vehicle telematics.
Life Insurance Fraud
Faking death or disability to collect life insurance benefits. Use thorough background checks, monitor for red flags in claims, and ensure regular policy review to prevent fraud.
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