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When looking at the characteristics of the insurance frauds
identified for this moment, it intensively observed that Accident
Investigation Report fraud is higher.
Self-destruction fraud
False documents fraud
Underwriting after damage
Other
Planned damage
Fake accident report fraud
3
7
10
13
16
51
%
When looking at what is done in the fight against insurance
fraud in European Countries, we see that it is carried out
combat with different legal and institutional sub-structures.
In Spain, it is considered as a criminal activity under the
Criminal Code of 1995. On an administrative level "supervi-
sory authority" has the right to make arrangements on insur-
ance fraud, to report insurance fraud to the specialized
institutions and to cooperate with domestic and foreign
authorities related to the subject.
Insurance frauds and combat with these has been always
one of the most important agendas of the insurance industry
in the world and in our country also. Insurance frauds
which increasingly diversified over time are considered to
be the most common economic crime after tax evasion in
developed countries. However, subject of fraud the nature of
the actions constantly changing shape according to the mea-
sures taken and that directs us to work towards the establish-
ment of a self-renewing systematically combat system.
Briefly, insurance fraud is described hiding an important
truth which will change the insurance company's decision
or deceiving of the insurer by the insured knowingly and
intentionally by means of a statement unrealistic.
In the literature it is encountered in two different processes
with the cases of Insurance fraud.
1. At the stage of underwriting of the Policy
To give false information to the insurance company or
intentionally hide a critical issue in order to ensure that the
insurance company make the agreement which it will not
do under normal circumstances.
2. At stage of damage
To cause a damage intentionally or overestimate the
amount of the damage occurred. According to the data of
the European Insurance and Reinsurance Federation
(CEA), the insurance companies can detect only 5% -
10% part of the fraud.
''Coalition Against Insurance Fraud'' which is established in
the United States to combat frauds of insurance declared
that annual cost of the insurance frauds to the sector is
U.S. $ 80 billion. According to the data of Insurance Fraud
Bureau which was established to fight against insurance
frauds, the annual cost of fraud to the insurance sector is 1.9
billion GBP and this leads to 44 GBP additional costs per
1
2
Insurance Fraud
Business Analysis
Specialist
Ozan
ÖZDEMİR
ARTICLE
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