Browsing by Subject "fraud triangle"

Opportunistic insurance fraud has been given little attention in academic studies, even though it is estimated to account for the majority of insurance fraud. This global phenomenon distorts insurance markets, leading to higher premium prices for honest consumers. The motivation for this thesis is to gain deeper understanding of opportunistic insurance fraud, its causes, and to provide possible solutions to tackle it. This thesis provides a comprehensive literature review, combined with two theoretical models to study opportunistic insurance fraud. The first model introduced is the costly state verification model with two different auditing strategies. This model is used to find optimal insurance contracts under asymmetry. The second model is the fraud triangle with three elements: motivation, opportunity, and rationalization. In sum, the fraud triangle model explains opportunistic insurance fraud. The results from this analysis support the concept of a rational, utility maximizing consumer, whose main motivation for fraud is money. Opportunity is provided by the industry itself due to inadequate measures of detection and prevention. In addition, societal norms indicate a strong acceptance of fraudulent behavior, which is often seen as a victimless crime.