Resumen de Moral, Social, and Economic Dimensions of Insurance Claims Fraud

Sharon Tennyson

• Insurance claims fraud receives increasing attention in the insurance industry, in academic studies and in public policy spheres. Claims fraud is variously viewed as an economic-contractual problem, a moral-psychological problem, a moral-sociological problem or a criminal problem. This article discusses these theoretical perspectives on insurance claims fraud and reviews the empirical evidence on its nature and prevalence. Most research concludes that opportunistic soft fraud is more prevalent than planned criminal fraud, and that consumer ethics, attitudes and psychology are important aspects of the insurance fraud problem. On the contrary, much of the policy focus on reducing fraud has been directed toward detecting and criminalizing fraud. In light of existing research, care must be taken in applying these approaches to address soft fraud. Greater focus on the social and psychological dimensions of insurance claims fraud may increase the success of soft fraud prevention and decrease the likelihood that the focus on fraud will impair insurance relationships. Improving such prevention efforts requires a better understanding of the various dimensions of fraud, the determinants of fraud behaviors and the relationship between fraud behavior and the institutional setting.