This article explains about fraud in health insurance claims. It also apply to motor insurance.
Generally, the insurance companies are quite weak in managing fraud. The tools are available today for them to handle the fraud more effectively. But few insurance companies are up to date in dealing with this issue.
I quote the following examples of effective measures to handle fraud:
1) When a motorist meets with an accident, he will usually call the insurance company immediately. The hotline staff can advice him to take photos of the damaged vehicles and send them by email to the insurer immediately. This should be done before the vehicle goes to the repair shop. The insurer should have a database to store and retrieve thousands of photos efficiently.
2) Insurers struggle with bills sent by hospitals for various procedures and by repair shops for parts. They can collect the data based on past payments and find out the average price for each medical treatment or spare part. The claims staff can be alerted if any bill exceeds the average by a margin.
3) The insurers can be more pro-active in guiding their customers to the honest repair shops and hospitals. The customer can get better service quality and the insurer pay a lower price. The additional cost due to fraud is prevented.