The Impact of Insurance Fraud Detection Systems

The purpose of this paper is to characterize the impact of fraud detection systems on the auditing procedure and the equilibrium insurance contract, when a policyholder can report a loss that never occurred. Insurers can only detect fraudulent claims through a costly audit (costly state verification). With a fraud detection system insurers can condition their audits on the signal of the system and auditing becomes more effective. This paper presents conditions under which insurance fraud and the resulting welfare losses can be reduced by the implementation of a costly fraud detection system in a competitive insurance market that is supplied by an external third party.insurance fraud, auditing, detection systems

Contract design and insurance fraud: An experimental investigation

This paper investigates the impact of insurance contract design on the behavior of filing fraudulent claims in an experimental setup. We test how fraud behavior varies for insurance contracts with full coverage, a straight deductible or variable premiums (bonus-malus contract). In our experiment, filing fraudulent claims is a dominant strategy for selfish participants, with no psychological costs of committing fraud. While some people always commit fraud, a substantial share of people only occasionally or never defraud. In addition, we find that deductible contracts may be perceived as unfair and thus increase the extent of claim build-up compared to full coverage contracts. In contrast, bonus-malus contracts with variable insurance premiums significantly reduce the filing of fictitious claims compared to both full coverage and deductible contracts. This reduction cannot be explained by monetary incentives. Our results indicate that contract design significantly affects psychological costs and, consequently, the extent of fraudulent behavior of policyholders. --Insurance fraud,experiment,fairness,contract design,deductible,bonus-malus

Merging Automobile Insurance Regulatory Bodies: The Case of Atlantic Canada

The recent automobile liability insurance crisis in Atlantic Canada has prompted the four provincial legislations (Newfoundland and Labrador, New Brunswick, Nova Scotia and Prince Edward Island) to setup a task force to redesign, if necessary, the personal automobile insurance system. After reviewing some of the most interesting new regulatory changes, our paper proposes a new area of discussion: The merger of the four provincial insurance regulatory bodies to combat insurance fraud. We base our paper on the principle that recent premium increases are mainly due to an increase in insurance fraud. We show that merging the regulatory bodies may reduce insurance fraud if the merger allows savings on the average audit cost and on the development of better fraud detection technology. Finally, we suggest a fraud reducing insurance taxation scheme to finance insurance fraud investigations. La récente crise dans le Canada Atlantique au sujet de l'assurance de la responsabilité civile des automobilistes a contraint les gouvernements des quatre provinces (Terre-Neuve et Labrador, Nouveau-Brunswick, Nouvelle-Écosse et l'Île-du-Prince-Édouard) à mettre en place une commission pour étudier la possibilité de réorganiser, si nécessaire, leur système d'assurance automobile. Après avoir analysé les plus intéressantes modifications à la réglementation mises en place dans ces provinces, notre étude offre un nouveau terrain de discussion, soit la fusion des quatre réglementations provinciales afin de combattre la fraude à l'assurance. Notre étude se base sur le principe que les récentes augmentations dans les primes sont attribuables à une augmentation de la fraude à l'assurance dans ces provinces. En fusionnant les réglementations des quatre provinces, nous montrons que la fraude à l'assurance peut diminuer si la fusion permet d'épargner une partie du coût de vérification encouru par les assureurs lors de réclamations douteuses. Également, nous montrons qu'une telle fusion peut permettre de développer une meilleure technologie de vérification des réclamations. Nous terminons le papier en suggérant un système de taxation particulier qui non seulement peut financer les investissements nécessaires pour combattre la fraude, mais peut également réduire la fraude directement.insurance fraud, asymmetric information, insurance taxation, public policy, fraude à l'assurance, information asymétrique, taxation à l'assurance, politique publique

When prices hardly matter: Incomplete insurance contracts and markets for repair goods

This paper looks at markets characterized by the fact that the demand side is insured. In these markets a consumer purchases a good to compensate consequen¬ces of unfavorable events, such as an accident or an illness. Insurance policies in most lines of insurance base indemnity on the insured’s actual expenses, i.e., the insured would be partially or completely reimbursed when purchasing certain goods. In this setting we discuss the interaction between insurance and repair markets by focusing, on the one hand, upon the development of prices and the structure of markets with insured consumers, and, on the other hand, the resulting backlash on optimal insurance contracting. We show that even in the absence of ex post moral hazard the extension of insurance coverage will lead to an increase in prices as well as to a socially undesirable increase in the number of repair service suppliers, if repair markets are imperfect

Merging automobile regulatory bodies: The case of Atlantic Canada

The recent automobile liability insurance crisis in Atlantic Canada has prompted the four provincial legislations (Newfoundland and Labrador, New Brunswick, Nova Scotia and Prince Edward Island) to setup a task force to redesign, if necessary, the personal automobile insurance system. After reviewing some of the most interesting new regulatory changes, our paper proposes a new area of discussion: The merger of the four provincial insurance regulatory bodies to combat insurance fraud. We base our paper on the principle that recent premium increases are mainly due to an increase in insurance fraud. We show that merging the regulatory bodies may reduce insurance fraud if the merger allows savings on the average audit cost and on the development of better fraud detection technology. Finally, we suggest a fraud reducing insurance taxation scheme to finance insurance fraud investigations. --Insurance Fraud,Asymmetric Information,Insurance Taxation,Public Policy

Ökonomische Aspekte der Entlohnung und Regulierung unabhängiger Versicherungvermittler

Die Entlohnung und Regulierung unabhängiger Versicherungsvermittler, wird aktuell vor allem vor dem Hintergrund der Bedeutung und Zukunft der Honorarberatung und -vermittlung intensiv diskutiert. Im Rahmen des vorliegenden Beitrags werden zunächst wichtige ökonomische Erkenntnisse zur Vertriebswegewahl von Versicherungsunternehmen dargestellt. Aufbauend auf zentrale betriebs- und gesamtwirtschaftliche Funktionen unabhängiger Versicherungsvermittler wird untersucht, wie durch unterschiedliche Entlohnungsformen Vermittlern effiziente Anreize gesetzt werden können. In diesem Zusammenhang wird auch der Frage nachgegangen, ob und inwieweit Regulierungsmaßnahmen, wie zum Beispiel ein generelles Verbot oder die Offenlegung von Provisionszahlungen sowie das sogenannte ?Provisionsabgabeverbot?, notwendig und geeignet sind, die Effizienz von Versicherungsmärkten zu erhöhen.The compensation and regulation of independent intermediaries is an important issue in insurance markets. With this respect, the profitability and importance of fee-for-service and commission compensation of intermediaries is lively discussed in academia and in the insurance industry. This paper summarizes economic rationales why and in which lines of business insurance companies sell their products via independent intermediaries. With this respect, it is analyzed how different forms of compensation affect important market functions of independent intermediaries. Finally, the economic impact of certain regulatory interventions, like a mandatory disclosure or a general ban of any commissions and the German ban for intermediaries to share commission with policyholders, on market efficiency is discussed

When prices hardly matter: Incomplete insurance contracts and markets for repair goods

This paper looks at markets characterized by the fact that the demand side is insured. In these markets a consumer purchases a good to compensate consequen¬ces of unfavorable events, such as an accident or an illness. Insurance policies in most lines of insurance base indemnity on the insured’s actual expenses, i.e., the insured would be partially or completely reimbursed when purchasing certain goods. In this setting we discuss the interaction between insurance and repair markets by focusing, on the one hand, upon the development of prices and the structure of markets with insured consumers, and, on the other hand, the resulting backlash on optimal insurance contracting. We show that even in the absence of ex post moral hazard the extension of insurance coverage will lead to an increase in prices as well as to a socially undesirable increase in the number of repair service suppliers, if repair markets are imperfect.insurance; incomplete contracts; repair markets

When prices hardly matter: Incomplete insurance contracts and markets for repair goods

This paper locks at markets charaterized by the fact that the demand side is insured. In these markets a consumer purchases a good to compensate consequences of unfavorable events, such as an accident or an illness. Insurance policies in most lines of insurance base indemnity on the insured's actual expenses, i. e., the insured would be partially or completely reimbursed when purchased certain goods. In this setting we discuss the interaction between insurance and repair markets by focusing, on the one hand, upon on development of prices and the market structure in markets with insured customers, and, on the other hand, the resulting backlash on optimal insurance contracting. --insurance,incomplete contracts,repair markets

When prices hardly matter: Incomplete insurance contracts and markets for repair goods

This paper looks at markets characterized by the fact that the demand side is insured. In these markets a consumer purchases a good to compensate consequences of unfavorable events, such as an accident or an illness. Insurance policies in most lines of insurance base indemnity on the insured’s actual expenses, i.e., the insured would be partially or completely reimbursed when purchasing certain goods. In this setting we discuss the interaction between insurance and repair markets by focusing, on the one hand, upon the development of prices and the market structure in markets with insured customers, and, on the other hand, the resulting backlash on optimal insurance contracting.Incomplete Contracts, Insurance, Repair Markets

Intermediation, Compensation and Collusion in Insurance Markets

Recent events involving major insurance companies and insurance brokerage firms highlight substantial incentive problems in commercial and reinsurance markets where intermediation takes place. We show that in markets with informed as well as uninformed consumers and heterogeneous risk profiles intermediation has the potential to improve social welfare. However, since intermediation reduces insurers’ market power, incentives for tacit collusion are higher compared to markets without intermediation. A controversial matter in the discussion concerning insurance intermediation is the issue of compensation customs. Our analysis provides explanations for the counterintuitive observation that brokers are usually compensated by insurance companies. The rationale for the latter is the fact that a fee paid by uninformed consumers limits the insurers’ ability to extract rents from informed consumers.insurance; brokerage; collusion; compensation; information