STUDY OF THE DETECTION AND CHECKS OF CLAIMS FRAUD IN THE INSURANCE INDUSTRY
Abstract
A examine of the detection and assessments of claims fraud operation begins offevolved from the advise insured who gives a commercial enterprise settlement to the insurer through finishing the notion shape questions with suitable answers.
The insurer at the frequently difficult investigate the paid of the insured earlier than the insured should route for the agreement of claims and the coverage holder need to come for the declare, at once the loss has been sustained.
The insured will notify and clean his thoughts from fraudulent enterprise in different to go into for a criminal settlement with the coverage enterprise. The different hand of the detection frame the insurer and the insured will so into inspection earlier than any hazard may be settled extra so the coverage proof of settlement among the insured and the insurer and it’s miles nicely hooked up in regulation that standard wile of competition and interpretation shall practice to coverage contracts in addition to to different contacts. Checking operation the insured display his obligations in enlightening the insured how a hazard or peril need to be prevented and instead imp stressed the coverage holders risks.
The goals of this assignment is to examine the detection and assessments of claims fraud maximum in particular in Nigeria due to the sick knowledgeable humans in Nigeria who couldn’t input into coverage coverage due to the fact they be stay that God will insure them end all of the coverage corporations need to take steps in making sure the wording of the coverage are physical written in order that one could now no longer want to stress the eyes earlier than being capable of examine via the strains of published phrases and that they need to don’t forget using easy and comprehensible English language even as drafting the coverage. Ambiguous phrases need to now no longer be used. Appropriate income manufacturing scheme or marketing and marketing channel ought to be taken.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF STUDY
The examine of the detection and assessments of claims fraud withinside the Nigerian coverage company or group and the reasons additionally the solution. Insurance declare rise up while a loss occurred. In the prevalence of loss. He insured is anticipated notify the insurer at once the loss occurred. The coverage need to then ahead a declare shape to the Clurman the coverage additionally open a report stop register, cautiously research are done on the problem of the loss earlier than the claims may be settled. It can both be through cash, repaint alternative or reinstatement relying at the approach presenting for as agreed on the approach presenting for as agreed on the inception of the settlement
Fraud is likewise as defecation. It is approach the act of creating a few entries in different to misappropriate a few items or money, such method can be executed through an character or institution of people with out the information of the control committee so as to of defrauding the coverage enterprise.
It can curse while declare fraud is detected from fictitious fee withinside the cashbook or inventory records, withinside the case of items. It has expanded in length and utilized in acquiring tremendous state-of-the-art through the day.
Currently with the creation of modem coverage approach computerized digital device conversation machine and pc into the coverage enterprise frauds have already taken a one of a kind form and a few concerned boom unexpectedly in an impediment to boom of coverage enterprise. It became found throughout research, broking now take more care earlier than clearing declare because of rampant instances of fraud and forgery wherein or coverage enterprise Bose positioned on the pinnacle in Nigeria. Fraud has turn out to be state-of-the-art as to make solid declare in order that coverage enterprise will conform to compensate the insured.
In a bid to lessen the prevalence and length of fraud in Enugu.
1.2 STATEMENT OF PROBLEM
Insurance company has played a special role to the society but there are many problems facing the company.
i) Ill educated people in the society due to the high illiteracy in our society makes the insurance to have difficult problem enlightening them how to improve their risk
ii) Government not looking into insurance company problems and providing them with adequate facilities for the detecting of fraud.
iii) The police insured and claim investigator working in hand to defraud the insurance company.
iv) The insurance officials refuse to give enough information due to bias mind to defraud the insurance company.
1.3 PURPOSE / OBJECTIVE OF STUDY
The researcher having successfully indicated the numerous problems obtained on insurance claim fraud in insurance institution will now state the purpose of carrying research work.
i) To eliminate various types of claims fraud.
ii) To determine the causes of fraud in insurance industry.
iii) To observe if there legal loopholes. In Nigeria legal system that encourage frauds.
iv) Determination of control measure and strategies against fraud and making of vital recommendation.
1.4 SIGNIFICANCE OF THE STUDY
The system used in checking these fraud and insurance claim acquire greater sophistication by the day. As insurance company in Enugu state are busy finding the way of controlling fraud and settling claims, the fraudsters in connection with some dishonest insurer device new system of doping or robbing the company.
In addition, it should be noted that the results of these ugly cases are damaging
i) Fraud brings about unwanted losses for an insurance company and equally put the management on a confused state of mind while spending hard-neared resources on fraud control.
Any case of insurance company clips off a bit of public trust in financial institution and well so down the development of banking habits.
Moreover, it can easily be noticed that if nothing is done to control these ugly incidence fraud could lead to the total collapse of the economy.
Thus researcher tend to look into this research work the major of the detection and checks of claims have with intention to provide suitable recommendation that will help in fraud control and insurance claims.
1.5 SCOPE AND LIMITATION OF THE STUDY
This work entitle the detection and checks of claims fraud, but for the purpose of this research work, it has been shorten 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 detection of claims fraud. The objectives of the detection and checks of claim fraud. The firm 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 research during the research work. Some of them are on follows.
1. Time factor
2. lack of fund
3. Weather condition
4. lack of good network of wad
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 topic researchable.
Lack of fund: This acted as obstacle during the project work, during the time of the research there were no enough fund to visit some place for data collection
WEATHER CONDITION: Due to the fact that we are on rainy season. It was not all that possible to go to many places for data collection.
LACK OF GIXID NETWORK OF ROAD: The roads are not well linked up and most of them are bad that one not drive through daring data collection.
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