General Insurance Fraud Prevention Fundamentals - OESAI

Description

The costs of insurance fraud are a threat to the insurance industry’s financial stability and, therefore, a threat to the public. Many organizations, including insurers, law enforcement agencies, regulators, and legislators, have launched efforts to combat insurance fraud using various methods including training.

Staged car accidents, workers’ compensation medical bills, and massive fraud rings involving millions of dollars and sometimes hundreds of participants including drivers, patients, doctors, lawyers, and police officers—these things grab our attention. This is general insurance fraud.

General insurance fraud is a major problem. It is estimated that fraud accounts for about 30-40 percent of the money that insurers pay for general insurance claims.

Learning Outcomes

After completing this training, you will be able to:

• List the most important property and casualty insurance products
• Describe personal automobile insurance
• Explain how some of the most common automobile insurance fraud schemes work
• Describe workers’ compensation insurance
• Describe claim fraud and premium (application) fraud in workers’ compensation insurance
• Identify some of the tools property/casualty insurers use to fight fraud
• Discuss some of the legal and investigative issues

Programme Outline

• Introduction to Insurance Fraud
• The Insurance Products
• Automobile Insurance Fraud
• Workers' Compensation Fraud
• Other Property / Casualty Insurance Fraud
• Combating Insurance Fraud
• Legal and Investigative Issues