FSP 303 Insurance Fraud Investigation

Mode of Study -- Online
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    Course Outline

    Insurance Fraud Investigation

    Insurance fraud, may be defined as, act committed with an intent to obtain a fraudulent result from an insurance process. This may occur when a claimant attempts to obtain some benefit to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation the most common schemes include: Premium Diversion, Fee Churning, Asset Diversion, and Workers Compensation Fraud. The perpetrators in these schemes can be both insurance company employees and claimants. False insurance claims are insurance claims filed with an intent to deceive an insurance provider.


    Insurance fraud has existed since the beginning of insurance as a commercial enterprise.  Fraudulent claims account for a significant portion of all claims received by insurers, and cost billions of dollars annually. Types of insurance fraud are diverse, and occur in all areas of insurance. Insurance crimes also range in severity, from slightly exaggerating claims to deliberately causing accidents or damage. Fraudulent activities affect the lives of innocent people, both directly through accidental or intentional injury or damage, and indirectly as these crimes cause insurance premiums to be higher. Insurance fraud poses a significant problem, and governments and other organizations make efforts to deter such activities.


    The chief objective in all insurance crimes is financial profit. Insurance contracts provide both the insured and the insurer with opportunities for exploitation and manipulation. According to the Coalition against Insurance Fraud, the causes vary, but are usually centered on greed and holes in the protections against fraud. Often, those who commit insurance fraud view it as a low-risk, well-paid enterprise. Drug dealers who have entered insurance fraud think it’s safer and more profitable than working street corners. Compared to other crimes, court sentences for insurance fraud can be lenient, so scammers may try to take advantage of the system. Though insurers try to fight fraud, some will pay suspicious claims, since settling such claims is often cheaper than legal action.


    This course would offer the students to prove the mettle of their skill by learning various techniques that may be acquired to enhance their skills and career in the Insurance Fraud Investigating companies and firms.