Study Of The Detection And Checks Of Claims Fraud In The Insurance Industry
Abstract
A study of the discovery and checks of claims fraud operation starts from the propose ensured who offers a business contract to the insurer by completing the offer form questions with applicable answers.
The insurer on the frequently hard check the paid of the ensured before the ensured could course for the agreement of claims and the policy holder should come for the claim, incontinently the loss has been sustained.
The ensured will notify and clear his mind from fraudulent company in other to enter for a legal contract with the insurance company. The other hand of the discovery body the insurer and the ensured will so into examination before any threat could be settled more so the policy substantiation of contract between the ensured and the insurer and it’s well established in law that general wile of contention and interpretation shall apply to insurance contracts as well as to other connections. Checking operation the insured show his liabilities in enlightening the ensured how a threat or pitfall should be avoided and rather imp wired the policy holders pitfalls.
The objects of this design is to study the discovery and checks of claims fraud most especially in Nigeria because of the ill educated people in Nigeria who couldn’t enter into insurance policy because they be live that God will ensure them conclusion all the insurance companies should take way in icing the wording of the policy are fleshly written so that one would not need to strain the eyes before being suitable to read through the lines of published words and they should consider the use of simple and accessible English language while drafting the policy. nebulous terms shouldn’t be used. Applicable deals product scheme or advertising channel must be taken.
Chapter One
Preface
Background Of Study
The study of the discovery and checks of claims fraud in the Nigerian insurance establishment or institution and the causes also the result. Insurance claim arise when a loss passed. In the circumstance of loss. He ensured is anticipated notify the insurer incontinently the loss passed. The insurance should also further a claim form to the Clurman the insurance also open a train end register, precisely disquisition are carried out on the issue of the loss before the claims could be settled. It can either be by cash, repaint relief or reinstatement depending on the system furnishing for as agreed at the system furnishing for as agreed at the commencement of the contract
Fraud is also as defecation. It’s means the act of making some entries in other to boost some goods or plutocrat, similar approach may be performed by an individual or group of individualities without the knowledge of the operation commission with the intention to of defrauding the insurance company.
It can curse when claim fraud is detected from fictitious payment in the cashbook or stock records, in the case of goods. It has increased in size and used in carrying great sophisticated by the day.
presently with the preface of modem insurance system automatic electronic contrivance communication system and computer into the insurance assiduity frauds have formerly taken a different shape and some involved increase fleetly in an handicap to growth of insurance assiduity. It was discovered during disquisition, broker now take redundant care before clearing claim due to rampant cases of fraud and phony in which or insurance company Bose placed on the head in Nigeria. Fraud has come sophisticated as to make forged claim so that insurance company will agree to compensate the ensured.
In a shot to reduce the circumstance and size of fraud in Enugu state insurance company. The insurance workers now take acceptable measures before settling or compensating a claim. These measures bring into causes of detention in claim agreement.
The reason for this experimenter work is to identify the study of the discovery and checks of claims fraud in insurance companies in Enugu state, Nigeria have recommended more important or vital measures that will help in the controlling of frauds in insurance company.
Statement Of Problem
Insurance company has played a special part to the society but there are numerous problems facing the company.
i) Ill educated people in the society due to the high ignorance in our society makes the insurance to have delicate problem enlightening them how to ameliorate their threat
ii) Government not looking into insurance company problems and furnishing them with acceptable installations for the detecting of fraud.
iii) The police insured and claim investigator working in hand to defraud the insurance company.
iv) The insurance officers refuse to give enough information due to bias mind to defraud the insurance company.
Purpose/ Ideal Of Study
The experimenter having successfully indicated the multitudinous problems attained on insurance claim fraud in insurance institution will now state the purpose of carrying exploration work.
i) To exclude colorful types of claims fraud.
ii) To determine the causes of fraud in insurance assiduity.
iii) To observe if there legal loopholes. In Nigeria legal system that encourage frauds.
iv) Determination of control measure and strategies against fraud and timber of vital recommendation.
Significance Of The Study
The system used in checking these fraud and insurance claim acquire lesser complication by the day. As insurance company in Enugu state are busy chancing the way of controlling fraud and settling claims, the fraudsters in connection with some dishonest insurer device new system of doping or stealing the company.
In addition, it should be noted that the results of these unattractive cases are damaging
i) Fraud brings about unwanted losses for an insurance company and inversely put the operation on a confused state of mind while spending hard- neared coffers on fraud control.
Any case of insurance company clips off a bit of public trust in fiscal institution and well so down the development of banking habits.
also, it can fluently be noticed that if nothing is done to control these unattractive prevalence fraud could lead to the total collapse of the frugality.
therefore experimenter tend to look into this exploration work the major of the discovery and checks of claims have with intention to give suitable recommendation that will help in fraud control and insurance claims.
Compass And Limitation Of The Study
This work entitle the discovery and checks of claims fraud, but for the purpose of this exploration work, it has been dock down to contain only the miscuing of claims and fraud also it could be checked the problems encountered by the insurance company when carrying out the work of the study of the discovery of claims fraud. The objects of the discovery and checks of claim fraud. The establishment also cover the areas of raising defrauding claims and checks in an insurance institution in Enugu state.
Limitation
These use factors that limit or affect the exploration during the exploration work. Some of them are on follows.
1. Time factor
2. lack of fund
3. Weather condition
4. lack of good network of gob
5. lack of power
6. lack of data
Time factor during the work there was no enough time to conduct the study in order to make the content researchable.
Lack of fund This acted as handicap during the design work, during the time of the exploration there were no enough fund to visit some place for data collection
Rainfall CONDITION Due to the fact that we’re on stormy season. It wasn’t all that possible to go to numerous places for data collection.
LACK OF GIXID NETWORK OF ROAD The roads aren’t well linked up and utmost of them are bad that one not drive through enterprising data collection.
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