[reproduced] America automobile insurance fraud experience

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  • / Author: Aaron Lewis
According to America insurance anti fraud union estimates, takes place every year in USA insurance fraud is about $80000000000, an average of $950 per family, each American citizen $326.47. Auto insurance, industrial injury insurance and health insurance is considered the three hardest hit USA insurance fraud. Research American Insurance Research Council in 1996 found that, 1/3 car collision accident and insurance fraud; every three caused by a collision of the vehicle personal injury claims have alleged fraud, every dollar paid the claims of a 17-20 cents to compensate for the fraud, the annual car insurance consumers increase due to fraud costs as high as 52 - 6300000000 dollars. National Insurance Crime Bureau (National Insurance Crime Bureau) officials fraud has a vivid metaphor of insurance: if the America implementation of insurance fraud is a company to say, then the company's annual revenue from insurance fraud and theft of vehicles and revenue, enough to make the company among the world top 500 in the top 25, but the industry's growth.
   From twentieth Century since 80, USA began to counterattack of motor vehicle insurance fraud. Insurance company is an important subject American insurance fraud, which not only plays a specific counter measures of micro level execution of the work, but also responsible for the industry level and the macro level of insurance fraud to provide the basic data of the work. In American, most state legislation requires the insurance business in a certain size (also called the minimum scale, such as the effective policy in more than 3000 photos etc.) insurance company must set up special anti fraud agency -- special investigation section (SIU:Special lnvestigation Unit) engaged in anti fraud work, due to the above the lowest scale most insurance companies have set up special business scale investigation on the requirements, so the special investigation section has also become an important carrier America insurance company insurance fraud. The main work is in the investigation of suspected cases, and also for the other departments of the company staff special anti fraud training.
   In the above idea, after 20 years of continuous insurance fraud, USA gradually establish and perfect the related legislation, formed by the insurance company as the main body, including government departments, industry organizations and consumers against insurance fraud organization system, auto insurance fraud has become an important part of the insurance company business culture, summarizes including suspicious index method, information query, cross checking method, data analysis and data mining, and internal audit system, and achieved positive results. The basic experience in automobile insurance fraud America mainly:
    (a) fraud in the insurance anti's legal system more perfect system, insurance fraud has been achieved in the rule of law
   In USA, including insurance fraud, insurance fraud is not only regarded as a serious violation of the interests of victims, but also be regarded as a serious crime. It is based on such considerations, the legislature passed the bill on numerous car (insurance) insurance fraud regulation, insurance fraud has entered the track of the rule of law. The more common Bill: insurance fraud law (Insurance Antifraud Act), insurance fraud Bureau method (Insurance Fraud Bureau Act), insurance underwriting before checking method (Auto Pre-inspection Act), the special investigation branch law / regulations (Special Investigation Unit Act / Regulation) etc..
    (two) formed by the insurance company as the main body, including government departments, industry organizations and consumers, prevention of insurance fraud organizations
   In accordance with the law in most states American, satisfy a certain scale of business insurance companies bear the establishment of institutions -- in their own special investigation section (SIU) of the statutory obligations, as insurance fraud standing, specialized agencies. The law also requires insurance companies to the formulation of a special anti fraud plan, the plan must be approved by regulatory agencies. The establishment of insurance anti fraud office in the State Insurance Department (The Fraud Bureau), specifically responsible for the insurance anti fraud work guidance, on major fraud investigation, consumer education and other services, and will be suspected of crime of fraud case to the procuratorial organs examine sue.
   Industry organization includes not only the insurance industry associations, institutions, is more like the insurance anti fraud union such institutions, as well as ISO (Insurance Service Office) industry bodies such as. The insurance industry association is responsible for the entire industry promotion and use of the same or similar anti fraud standards, founded in 1993, insurance fraud alliance is composed of consumer organizations, insurance companies, law enforcement institutions such as insurance fraud industry organization, the organization are mainly embodied in: promoting some legislation on anti fraud; anti fraud in the public education; act as industry fraud data storage, the effect of the exchange center. Since 1971, ISO has been the main provider American property and casualty insurance field information, main achievements in the aspects of the containment of insurance fraud is the establishment of the ISO Claim Search system, the system is currently claims comprehensive insurance data system American the largest, most comprehensive, connected by more than 2 terminal and insurance company, there are one hundred thousand the claims records are input to the system every day, can provide timely claims data query for insurance companies, so as to effectively combat the insurance fraud. Through education, consumer groups and individuals will consciously take against insurance fraud practices, and it will provide the relevant anti fraud case clues and information to the insurance company, insurance regulators.
    (three) auto insurance fraud has become the important composition America insurance company management culture
   After 20 years of practice, the insurance anti fraud not only become an important aspect of an insurance company, and has become an important part of insurance company management culture, which is mainly reflected in the following three aspects:
   1. auto insurance fraud is an important content of risk management of insurance companies. In essence, the insurance company is engaged in risk management activities, is the basic obligation of insurance company recognition, measurement, control of various risks. Auto insurance is a non life insurance company's main business of insurance, and is one of the most vulnerable of insurance fraud, the insurance fraud prevention is an important content of risk management of non life insurance companies.
   2. auto insurance fraud has become an important part of the internal control system of insurance company. In view of the structure, internal control mainly includes the control environment, risk assessment, control activities, information and communication, monitoring of five aspects, including control environment also includes the company's culture and management style and other factors, is the key factor to determine the tone of enterprise internal control. On one hand, insurance fraud is a kind of management culture, the culture has integrated the enterprise internal control (Internal Control Culture), has become an important factor of internal control environment; on the other hand the insurance anti fraud as an important management system, has become an important part of internal control system of insurance company.
   3. auto insurance fraud has become strengthen customer relationship management of insurance company, an important measure of social responsibility. The insurance company based on the auto insurance fraud counterattack and customer education, to convey to customers such as insurance fraud is a crime, the innocent consumers, insurance fraud is the final victim of new ideas; through public disclosure of major malignant insurance fraud cases, and a powerful blow, have certain positive role to curb vehicle insurance fraud, what is more important is to the public that the insurance company is responsible, have the ability to fight car insurance fraud, this to change people's Insurance Company error bias and has very important significance to increase the insurance company's public image.
    (four) gradually formed a set of auto insurance anti fraud methods
   American insurance company insurance anti fraud methods commonly used in accordance with the frequency of use of view respectively: manual Red Flag / key card, anti fraud awareness training, internal external database query, data query, internal audit, audio-visual materials, computer software, the survey of large companies report hotline, from the person under investigation to obtain information.
   Look on the whole, the insurance anti fraud methods USA roughly consists of the propaganda and education method, preventive recognition that key indicators, diversity survey method and data analysis method, the new method of four categories.
   In practice, America insurance companies often take the consumer oriented mass, guarantees, potential policyholders, internal staff, preventive education activities, in order to from the source to block the possible types of fraud. USA insurance company is also widely used in some key indicators (KPI) as the determination and identification of insurance fraud case basis (Checklists), the method is mainly based on the daily experience of the Claims Officer accumulation, has experienced strong features, is also very convenient, practical, accuracy is relatively high. Key indicators usually is based on the investigation personnel experience, with a certain degree of subjectivity, survey method and data analysis method can rely on the field investigation, investigators collision experiment, data mining and matching the scientific means of insurance fraud identification and judgment.
   In addition, USA insurance company also adopted such as senior insurance fraud detection and analysis technology, remote communication technology, business intelligence and other modern means of science and technology to detect and identify the insurance fraud.