Frauds in the insurance world have existed forever, that is why we can talk about how regular and common they are, but why do they continue to occur and there is no better control to avoid them? Stay reading and know which are the vertices that make it difficult to reduce fraudulent activities.
Although various measures have been implemented to reduce the amount of frauds in the insurance industry, there are many factors that prevent the percentage from being significantly reduced:
- Insurers that do not report: although the main problem is being able to identify fraud in time, the second step is the report, which is not carried out by the insurance companies, not all companies have a zero tolerance policy because they prefer to pay small claims, even if they are fraud, than to go to court and pay the costs of this process.
Also adding to this problem is that many insurers prefer to make a quick agreement in order to avoid multi-million dollar lawsuits. In these cases, it is vital that the figure of the investigator provides the necessary information to the company to be able to fight and defend the cases in court, however, those traditional companies, tied to manual processes and that do not bet on technological advances, are more vulnerable and susceptible to losing the cases they decide to report.
- Fragility of the health system: in all countries one of the preferred targets by scammers, professionals or not, is the health system, this due to the large number of patients and treatments that exist that insurers must process, such as Information in this area is extensive, it is difficult for insurance companies to analyze and detect possible cases of fraud. Another factor is cost control, which causes some doctors or health establishments to lend themselves to fraud to recover lost profits or obtain the money to cover maintenance fees.
- Immigrants are an easy target: Many scammers take advantage of the arrival of immigrants to deceive them, taking advantage of the fact that many of them do not speak the language of the country they have arrived in or do not have knowledge of how the movement of certain topics is. Because they are in an unfamiliar place, scammers know that gaining their trust is not such a difficult task and they have them as one of their preferred targets when running a scam.
Nothing else in the US there are states that do not have specific laws against insurance fraud, a reality that is reflected in several countries around the world, that is why many prosecutors do not dare to take these cases to court because legally they have few tools to win complaints, which can cost insurance companies a great deal of money.
Insurance fraud is a crime that everyone pays for, from businesses to consumers, from lawyers to doctors, from the wealthiest to the humblest citizen. The only way to reduce this crime and prevent citizens from paying very high premiums, consequences.
Insurance fraud is a crime that everyone pays for, from businesses to consumers, from lawyers to doctors, from the wealthiest to the humblest citizen. The only way to reduce this crime and prevent citizens from continuing to pay very high premiums, consequences of this crime, is for everyone to be aware that fraud is a serious crime and that everyone who commits it must pay for it. Crime will only decrease when criminals can see that it is an easy way to end up in jail and not a way to make money without consequences.
LISA’s commitment is to support insurers in all their settlement processes in order to prevent fraud from the beginning to the end of all procedures, since we know that ailments of this type are very representative for policyholders and companies.