Insurance fraud : causes, characteristics and prevention

Although there is a growing volume of research on various kinds of fraud, relatively little has been written about insurance fraud. Even fewer studies have been undertaken on the prevention of insurance fraud. This study aims to fill this gap. It focuses not on large-scale corporate fraud but on individuals ‘fiddling’ their home, motor and travel policies. During the course of this study, the researcher surveyed the public and found that insurance fraud is commonplace, and committed by people of different classes— often unwittingly, and rarely with much regret. Insurance companies were surveyed, and data collected by interviews with insurance staff. It emerged that many insurers did not realise they had an insurance fraud problem, and those that did were either doing little to prevent it or were using ineffective methods. Insurance fraudsters are often given a great deal of help, often by officials who abuse the trust placed in them; insurers’ relationship with the police and with loss adjusters is not geared to stopping fraudsters, and insurance fraud is thus rendered easier. To illustrate this, and with the help of an insurance company, the researcher conducted a mock insurance fraud, and found it easy to commit. This study shows that insurance fraud is mostly an opportunistic crime. Within the study of crime prevention there is an approach which seeks to reduce the number of offences by curtailing the opportunities for crime. This is known as ‘situational crime prevention’, and is based on the ‘rational choice perspective’. Professor Ron Clarke, whose name is most closely associated with the approach, has called for more research to apply the principles and techniques of opportunity reduction to a range of crime types. This thesis represents an attempt to do this in relation to insurance fraud, and in so doing to stimulate ideas on how insurance fraud can be tackled effectively. In addition, it offers a new perspective on the situational approach and the techniques of opportunity reduction, plus a revised classification of these techniques. At the same time it offers a critique of the situational approach itself. The findings suggest that if fraud within the insurance industry is to be taken seriously then there are a range of structural concerns that need to be tackled, and that this moves beyond the scope of situational prevention.