Insurance fraud

Insurance fraud is intentional deception to obtain insurance payments or benefits unlawfully, or to evade legitimate insurance obligations.

Hard insurance fraud: Deliberate fabrication of an accident, loss, or injury to make a false insurance claim. A staged event creates the loss that the fraudster then claims against a policy.
Staged automobile accident: A deliberately caused or fabricated vehicle collision intended to support an insurance claim. It is a common hard-fraud scheme built around a fictional or engineered crash.
Insurance premium: The price paid for an insurance policy, usually at regular intervals. Insurers may incorporate expected fraud losses into premiums charged across a pool.
Insurance claim error: An inaccurate insurance claim caused by mistake rather than deliberate deception. An incorrect statement alone does not establish the intentional deception central to fraud.
Insurance fraud investigation: The collection and assessment of evidence about suspected deception involving insurance. Investigators must test suspicious claims against records, interviews, and physical evidence.
Soft insurance fraud: Exaggeration or misrepresentation added to an otherwise legitimate insurance claim. Inflated repair costs or injuries turn a real claim into a partly fraudulent one.
Arson for profit: The deliberate setting of a fire to obtain financial gain, often through an insurance claim. A property owner may destroy insured property to claim its value.
Insurance claim: A request to an insurer for payment or benefits under an insurance policy. Fraudulent claims exploit the ordinary process for requesting covered losses.
Insurance coverage dispute: A disagreement over whether an insurance policy covers a loss or requires payment. A disputed or denied claim can be legitimate without either party committing fraud.
Insurance fraud detection analytics: Computational methods that flag insurance transactions or claims as potentially fraudulent. Automated flags can prioritize review but may misclassify unusual legitimate claims.

Linked from 7 pages