Model for Insurance Fraud Risk Assessment and Prevention

Emil Asenov

doi:10.37075/YB.2017.1.04

Authors

Assoc. Prof. Dr Emil Asenov Department of Financial Control, Faculty of Finance and Accounting, UNWE Author

DOI:

https://doi.org/10.37075/YB.2017.1.04

Keywords:

Insurance frauds, Legal classification of insurance frauds, Insurance fraud risk assessment, Insurance fraud risk prevention

G17, G18, G22

Abstract

This article critically examines insurance frauds in terms of the risk they create and the significant losses they bring to the insurance industry. A comparative analysis of the classification of insurance frauds in the legal systems of many developed countries has been conducted. A model for risk assessment and the prevention of insurance frauds is presented. In the suggested model the overall risk assessment is achieved by the evaluation of risk elements – probability, exposure (frequency) and results. The possibilities for the practical application of the model of insurance frauds assessment and prevention in the insurance organizations practices have been outlined.

References

Riddle, Kelly E. (2004). Insurance investigations from A to Z. CreateSpace Independent Publishing Platform. ISBN: 1-4974-0320-0

Coalition Against Insurance Fraud estimate. (2017). URL: http://www.insurancefraud.org/statistics.htm (accessed 03.2015)

Todorov, Yu. (2011). Combating Insurance Fraud. University of Economics – Varna.

Bykova, N.V. (2009). The Concept of 'Insurance Fraud': Comparative Legal Analysis. Vestnik RUDN. Seriya: Yuridicheskie Nauki.

Strafgesetzbuch. URL: https://www.gesetze-im-internet.de/bundesrecht/stgb/gesamt.pdf (accessed 2017-11-08)

The Criminal Code. URL: http://www.isap.sejm.gov.pl (accessed 2017-11-08)

Wetboek van Strafrecht. URL: http://www.wetboek-online.nl (accessed 2017-11-08)

Kuller, J. M. & Reinhardt, G. R. (2011). Defending Against Insurance Fraud Claims: Leading Lawyers on Representing Insurers in Investigating and Preventing Fraudulent Activity. New York: West Publishing Co. ISBN: 9780314280091

B Zalma (2014). The Insurance Fraud Deskbook. Chicago: American Bar Association.

Morse, D. & Ackling, L. S. (2004). Insurance Fraud: Law and Practice. New York: Informa Law from Routledge (Practical insurance guides). ISBN: 9781138357402

Gill, Karen Ann (2003). Insurance Fraud: Causes, Characteristics and Prevention. Figshare, 240.

Smith, G., Button, M., Johnston, L., & Frimpong, K. (2010). Studying Fraud as White Collar Crime. UK: Palgrave Macmillan. ISBN: 9780230542495

J Lichtor (2002). Personal Injury Insurance Fraud: The Process of Detection: a Primer for Insurance and Legal Professionals. Arizona: Lawyers & Judges Publishing Company, Inc. ISBN: 9781930056343

Knoche, J. (1992). Der Anscheinsbeweis bei der Manipulation eines Verkehrsunfalls. Monatsschr. fur dt. Recht, 46(10), 919-922.

Putilina, I. (2010). Problems and Solutions for Fraud in the Insurance Sector. International Journal of Applied and Fundamental Research, 57-59.

Larichev, V. (1998). Fraud in the Insurance Sphere. Prevention, Detection, Investigation. Strahovanie segodnya. URL: https://www.insur-info.ru/press/40870/ (accessed 2016-10-01)

Lopashenko, N. (2002). Fraud in the Insurance Sector. Zakon.

Todorov, Yury (2007). Insurance Frauds in Bulgaria and Their Detection. Sofia: Albatros. ISBN: 978-954-751-079-1

Draganov, Hr. (2012). Analysis of the Activity of the Insurance Company. Trakia-M. ISBN: 978-619-7003-03-1