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Group 6 Unity
Hard fraud occurs when someone deliberately plans or invents a loss, such
as a collision, auto theft, or fire that is covered by their insurance policy
in order to receive payment for damages.
Soft fraud, which is far more common than hard fraud, is sometimes also
referred to as opportunistic fraud.This type of fraud consists of
policyholders exaggerating otherwise legitimate claims. Soft fraud can
also occur when, while obtaining a newinsurance policy, an individual
misreports previous or existing conditions in order to obtain a lower
premium on their insurance policy.
Where a person makes any representation as to fact or law which they know to
be untrue or misleading.
Where a person fails to disclose any information to a third party when they are
under a legal duty to disclose such information.
Where a person occupies a position where they are expected to safeguard the
financial interests of another person, and abuses that position; this includes
cases where the abuse consisted of an omission rather than anovert act.
Intermediary fraud
Internal fraud
Lost jobs
Personal costs
Insurance
company
to
have
Anti-Fraud Policy: There should be an Anti Fraud Policy containing well defined
procedures to identify, detect, investigate and report insurance frauds.
DETECTION
Detection methods
RESPONSE
Anti-Fraud Program
Investigation
Consequence Management
Thank You