Fraud Prevention

Rationalization, the last vertex of the fraud triangle

The last part of the fraud triangle refers to «rationalization,» or the reason the fraudster believes that insurance fraud is justified. Some of these frequent justifications may include the following:

01. «Everybody does it.»

Small-scale fraud is a common phenomenon in the insurance industry that anyone would think is easy to carry out.

Insurers are often seen as companies to whom a few dollars are no big deal and can be quickly recovered. Unfortunately, precisely this reasoning encourages people to commit more fraud.

02. «I have no other choice.»

If a person feels that they have a money or liquidity problem, it may cause them to be desperate. From this, the person will not think twice before committing fraud, as it may be the only option to get some money.

03. «I have not been treated as I expected.»

A person who feels that their insurance company has not treated them as they deserve may use this argument to commit fraud.

As 100seguro points out in one of its articles, people «allow» themselves to do what is not correct, convincing themselves that it is not theft but an act of justice.

Fighting insurance fraud with LISA Claims

At LISA Insurtech we use artificial intelligence and automation of processes and business rules to manage and resolve claims.  

The artificial intelligence analyzes both documentary and photographic evidence and is able to identify patterns, previously charged items or those with a higher than average value, frequency and severity, among others. This, in conjunction with a powerful static and dynamic rules engine fully managed by the user provides flexibility in adjusting rules and processes according to specific requirements.

These systems generate a significant increase in efficiency thanks to the self-learning nature of the process.

Go to the last article of this series.

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