Academic literature on the topic 'Twisting (Life insurance fraud)'

Insurance fraud is the most common form of fraud in the world, aside from tax evasion. By its very existence, the insurance industry is prone to deception. Basic income levels in Vietnam have a tendency to steadily rise as a result of improving socioeconomic conditions. As a result, the need for citizen security has increased and become more diverse.The aim of this study is to study the predictor/s of anti-insurance fraud among non-insurer companies in Vietnam. This study was conducted using a questionnaire that was completed by 51 employees who are currently working in the 11 non-life insurance company in Vietnam. It can be concluded that there exists a significant relationship between all the four independent variables which are namely external regulations, public context, management functions as well as underwriting guidance.

Insurance fraud affects nearly every industry in the world, costing companies and others that pay insurance premiums billions of dollars per year. Insurance fraud can be found in almost any area of business where liability insurance is carried and intended to protect consumers; illegal activity can be detected in almost any field of business where liability insurance is carried and intended to protect consumers. The aim of this study is to study the predictor/s of anti-insurance fraud among non-insurer companies in Vietnam. This study was conducted using a questionnaire that was completed by 51employees who are currently working in the 11 non-life insurance company in Vietnam. It can be concluded that there exists a significant relationship between all the three independent variables which are namely claim procedure as well as business operation management and the dependent variable which is anti fraud procedure.

Purpose – Although perceived as a wrong act, insurance fraud is a prevalent phenomenon. The purpose of this paper is to understand the psychological factors that lead to reporting an exaggerated/false insurance claim would enable insurance companies and policy makers to devise better preventive policies. Design/methodology/approach – Utilizing data-driven clustering techniques on psychological and demographic measures from 985 insurance customers in Europe, this study outlines profiles of segments of customers as it relates to dishonesty in dealing with insurance companies. The segmentation criteria include attitude toward insurance fraud, perceived probability of punishment, basic human values and morals, religiosity, life satisfaction and demographic characteristics. Findings – Results reveal the existence of four market segments. The segments include non-conservatives (sensitive to both perception of wrong behavior and the monetary payoff for a fraudulent claim), self-protectionists (sensitive to the probability of being caught), hedonists (sensitive to the personal pleasure and monetary payoffs for insurance fraud) and socially focused individuals (sensitive to social norms regarding admitting to having committed insurance fraud). Among the demographic variables, only education and among psychological variables, universalism, hedonism, security, conformity, tradition, benevolence, moral philosophy, religiosity, perceived probability of punishment and attitude toward insurance fraud were significantly different among the four identified segments. Practical implications – Specific policies are proposed in order to prevent insurance fraud, tailored to the specific profile of each segment. Originality/value – Using a psychological perspective and a data-driven methodology, this study identifies four heterogeneous segments of unethical insurance customers with dissimilar values, attitudes toward fraud and perception of punishment probability.

This This research aims to determine fraud prevention from religiosity, protection whistleblower, and whistleblowing system perspectives. The population in this research was employees of PT Prudential Life Assurance. The population is taken without distinguishing gender, education, and work experience and taken from 43 as the total number of insurance employees. This study used saturated samples or census as the sampling technique, whereas all population employs as samples. The research data uses primary data obtained by researchers by giving questionnaires (structured questions) to insurance employees. The research analysis was conducted with multiple linear regression analysis. The results showed that religiosity and whistleblower prevention did not affect fraud prevention. The absence of the effect of whistleblower protection on fraud prevention shows that the protection for whistleblowers is not yet adequate. The existence of intimidation, injustice and law enforcement are reasons why individuals are reluctant to become whistleblowers. However, whistleblowing intention affects fraud prevention. These findings indicate that human actions are influenced by their intentions, attitudes and subjective norms.

In this paper, the author analyses a few examples of fraud in life and accident insurance. The cases that are the subject of this Article can be classified as "heavy frauds" according to the seriousness of the crime committed and as "external" according to the source type. The course and epilogue of the trials show how important it is to have the closest possible coordination between the judicial, police and insurance institutions and that the character of insurance frauds is becoming increasingly international, requiring stronger cross-border inter-institutional cooperation. Also, experts from a growing number of disciplines (from medicine, through mechanical engineering to technological sciences) do have a particularly notable role in discovering false insurance claims. Their expertise findings can make a decisive contribution to clarifying the circumstances of each and every case. The examples presented in this Article illustrate that closer cooperation between all the named participants and the use of advanced methods and technologies are the indispensable tool of a good and a more efficient fight against the insurance fraud.

Purpose In the insurance industry, it is common for the insurance salespeople to sell insurance products to friends, relatives and associates. However, permitting (or encouraging) salespeople to sell insurance through personal relationships may result in some ethical conflicts. For example, some insurance salespeople may help relatives or friends with pre-existing medical conditions buy the health insurance. Previous studies on insurance fraud have rarely focused on this problem. Thus, this study aims to investigate the effects of guanxi (guanxi refers to the durable social connections and relationships a Chinese person uses to exchange favors for a specific purpose) on the salespeople’s acceptance of customer–salesperson collusions. Two types of guanxi are discussed in the research. The author further focuses on how the ethical attitudes and intentions are affected by the salespeople’s guanxi considerations, consequence evaluations, perception of peers’ attitudes, perceived harm to other policyholders and perceived probability of being caught. Design/methodology/approach Full-time life insurance salespeople from Taiwan were surveyed, and partial least squares method was used in the study. Findings The results showed that the types of guanxi, guanxi considerations, consequence evaluations, perception of peers’ attitudes and perceived harm to other policyholders were important in forming the salespeople’s ethical decision-making in the customer–salesperson collusions. Originality/value This is the first time that guanxi has been studied as the factor influencing collusive behaviors in the problems of insurance fraud. The results challenged an established belief that the insurance salespeople should first target close relations as they build their portfolio of customers.

In July of 1826, a financial panic on Wall Street caused several companies to fail abruptly and precipitated runs on two of New York City's fifteen banks. Life and Fire Insurance became the largest of the bankruptcies. In violation of New York's banking statutes, the firm had engaged in lending on a massive scale during the speculative boom that prevailed in 1824–25. Innovative lending techniques had been developed outside the traditional banking sector—in this case, in the insurance industry. These lending practices, based on an instrument known as a post note, were initially sound, but were later extended to riskier borrowers and ultimately proved ruinous. In the credit crisis that began in late 1825, the value of the Life and Fire's assets fell dramatically, and in a desperate effort to raise cash, the directors resorted to fraud.

Apdrošināšanas nozare kā valsts finanšu sistēmas sastāvdaļa, līdzīgi kā kredītiestāžu joma, satur reālu risku un nav pilnībā aizsargāta no iespējamām prettiesiskām darbībām ar noziedzīgi iegūtiem līdzekļiem. Galvenokārt noziedzīgi līdzekļi apdrošināšanas nozarē var tikt ģenerēti ar apzināti nepamatotiem apdrošināšanas atlīdzību pieteikumiem, kurus apdrošinātāji nav spējīgi identificēt vai pierādīt pieteicēju krāpniecisko rīcību. Krāpnieciskā rīcība pret apdrošinātāju var izpausties kā apdrošināšanas objekta apzināta bojāšana, lai saņemtu apdrošināšanas atlīdzību, vai kā pārspīlēta prasība naudas izteiksmē, vai arī kā apdrošināšanas gadījuma imitācija. Kaut arī dzīvības apdrošināšana pasaulē vairāk pakļauta noziedzīgi iegūtu līdzekļu legalizācijas riskam, Latvijas dzīvības apdrošināšanas nozarē šajā ziņā aktivitāte nav vērojama. Savukārt nedzīvības apdrošināšanas joma ir vairāk pakļauta krāpšanas riskam un daudz biežāk saskaras ar viltus pieteikumiem nekā dzīvības apdrošināšanā. Latvijā līdz šim problēma nav aktualizēta un netika risināta pietiekamā līmenī. The insurance industry as a part of national financial system the same as credit institutions contains a real risk and is not fully protected from possible illegal activities with the proceeds of crime. In the insurance sector, mainly criminal funds can be generated by deliberately unreasonable insurance claims that insurers are not able to identify or prove the applicant’s fraudulent conduct. Fraudulent action against the insurer may take the form of insurance object damaging for obtaining insurance reimbursement, as well as by exaggerated requirement in terms of money and imitation of insurance cases. While the life insurance in the world is more exposed to money laundering risks, there is no activity in this regard in Latvian life insurance sector. By contrast, non-life insurance sphere is more exposed to the risk of fraud and more often confronted with false claims than life insurance. In Latvia, the problem not yet actuated and adequately solved.

Life insurance policy is a contract between the policy holder (assured) and the insurer (insurance company), where the insurer promises to pay a designated beneficiary a sum of money (a “premium”) upon the death of the insured person. In return, the policy holder agrees to pay a stipulated amount (at regular intervals or in lump sums). In nutshell, life policies are legal contracts and the terms of the contract describe the limitations of the insured events. Specific exclusions are often written into the contract to limit the liability of the insurer; common examples are claims relating to suicide, fraud, war, riot and civil commotion. Suicide means a wilful and intentional act on the part of the self-destroyer. It includes every act of self-destruction. Policies of life insurance contain conditions by which the liability of the insurer is modified and limited in case of suicide by the assured. Where there is such a clause in a policy, the insurer can avoid the policy. The position in England and in India is different on this issue. In England suicide is a crime and hence no money is payable if a person commits suicide while in a sane state of mind. On the other hand if the assured was insane at the time of committing suicide, the sum due can be recovered by his legal representatives. Under the Indian law, suicide in itself is not an offence, and as such a policy cannot be avoided on the ground of suicide, unless the policy otherwise provides. Suicide will, however, not affect the rights of assignee, if the policy holder had assigned the policy for valuable consideration. The burden of proving suicide is upon the insurers and where the cause of death is not known, the presumption is against suicide and the policy cannot be avoided. This same is followed in India. According to this approach, the claim would be barred on a contractual level because the assured cannot be the author of his own loss, and on a broader level, because the law will not allow him to benefit from his own criminal acts. This paper examines the development of law and policy in relation to claims on life insurance policy where the assured or insured has committed suicide after the commencement of the policy and the effect of suicide clause in life insurance contract. Is that the present practice of insurance companies to insert suicide clause in life policies, indirectly promotes commercial suicide in cases of intentional suicides.

Background: Compliance is a fact of life for interventional pain physicians (IPPs). The health care industry is highly regulated by federal and state governments. IPPs must understand and comply with a broad regulatory landscape that ranges from health care fraud to the prescribing of oral narcotics. Complying with all of these laws requires a proactive approach by an IPP in both the practice and business of medicine. Objectives: This article provides: 1) a brief discussion of the health care laws that IPPs must navigate in their practices; and, 2) practical steps that IPPs can take to ensure that they comply with the relevant laws. Discussion: IPPs should familiarize themselves with the major federal and state fraud and abuse laws that apply to all interventional pain practices. IPPs should also implement effective compliance programs that include tools such as auditing, education, and employee reporting designed to uncover and correct fraud and abuse. Conclusion: Once in place, a compliance program can easily become part of a practice’s culture and pay for itself many times over in problems avoided. IPPs that implement appropriate compliance programs can focus on the most important part of their practice: taking care of patients. Key words: Interventional pain practices, compliance, health care laws, federal, state, fraud, abuse, auditing, education, compliance program, health care industry, False Claims Act, Anti-Kickback Statute, Physician Self-Referral Proscription, Health Insurance Portability and Accountability Act