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Claims, Cost and Crimes - A Study of Insurance Frauds From Invention to Prevention

NCJ Number
96892
Author(s)
L S Cole
Date Published
1984
Length
113 pages
Annotation
Homeowner's insurance, automobile insurance, fire insurance, and marine insurance are discussed, and ways in and marine insurance are discussed, and ways in which insurers are defrauded are examined.
Abstract
A list of accepted terms and definitions within the insurance industry is provided. Various means of cheating automobile insurers are described. The simplicity of automobile insurance fraud is attributed to several factors, including: (l) drivers licenses may be obtained in many different names and (2) the issuance of an insurance policy is based on the assumed honesty of the person to be insured. Characteristics of both simple and complex fraud are divulged; false claims that may be submitted by those with homeowner's insurance are considered. The concept of 'bad faith' is explored, and circumstances that appellate courts have held to constitute bad faith are delineated. These include (l) an insurer cannot reasonably deny payment to an insured without thoroughly investigating the reason for the denial and (2) the insurer may not make deceptive representations to the insured. Also discussed are maritime frauds and the staging of accidents. Arson is analyzed as a form of insurance fraud; motives for incendiary fire, including jealousy and revenge, are enumerated. Suggestions for determining whether additional investigation is warranted in a house fire are provided, and a suspicious claim profile is included. Finally, model legislative acts relating to insurance fraud are addressed. Eighteen references are included.

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