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Insurance Fraud and Optimal Claims Settlement Strategies

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Author Info
Crocker, Keith J
Tennyson, Sharon
Abstract

We examine the optimal claims settlement strategy for a liability insurer when claimants can permanently misrepresent their losses by engaging in costly claims falsification. In this environment, claims auditing is not a possible deterrent to fraud, and the settlement strategy consists of an indemnification profile that relates the insurance payment to the claimed amount of loss. The optimal indemnification profile is shown to involve systematic underpayment of claims at the margin as a means to deter loss exaggeration, with the extent of underpayment limited by expected litigation costs and potential bad-faith claims. The key testable implication of the theory is that the extent of underpayment should be greater for classes of claims for which loss exaggeration is easier. Empirical analysis of insurance settlements for bodily injury liability in automobile accidents confirms this prediction. This suggests that liability insurers optimally choose claims payment strategies to lessen a claimant's incentive to exaggerate losses. Copyright 2002 by the University of Chicago.

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Publisher Info
Article provided by University of Chicago Press in its journal Journal of Law & Economics.

Volume (Year): 45 (2002)
Issue (Month): 2 (October)
Pages: 469-507
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Handle: RePEc:ucp:jlawec:v:45:y:2002:i:2:p:469-507

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  1. Dionne, Georges & Giuliano, Florence & Picard, Pierre, 2009. "Optimal auditing with scoring: theory and application to insurance fraud," MPRA Paper 18374, University Library of Munich, Germany. [Downloadable!]
    Other versions:
  2. Dionne, G. & Michaud, P.C. & Dahchour, M., 2004. "Separating moral hazard from adverse selection in automobile insurance : longitudinal evidence from France," Discussion Paper 79, Tilburg University, Center for Economic Research. [Downloadable!]
    Other versions:
  3. Bénédicte Coestier & Nathalie Fombaron, 2003. "L'audit en assurance," THEMA Working Papers 2003-41, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise. [Downloadable!]
  4. Miguel Santolino & Jean-Philippe Boucher, 2009. "Modelling the disability severity score in motor insurance claims: an application to the Spanish case," IREA Working Papers 200902, University of Barcelona, Research Institute of Applied Economics, revised Jan 2009. [Downloadable!]
  5. Mercedes Ayuso & Miguel Santolino, 2008. "Forecasting the maximum compensation offer in the automobile BI claims negotiation proces," IREA Working Papers 200807, University of Barcelona, Research Institute of Applied Economics, revised May 2008. [Downloadable!]
  6. Domenico Scalera & Alberto Zazzaro, 2007. "The Unpleasant Effects of Price Deregulation in the European Third-Party Motor Insurance Market: A Theoretical Framework," The B.E. Journal of Economic Analysis & Policy, Berkeley Electronic Press, vol. 7(1). [Downloadable!]
  7. Mercedes Ayuso(universitat de Barcelona) & Miguel Santolino(Universitat de Barcelona), 2009. "Individual prediction of automobile bodily injury claims liabilities," Working Papers in Economics 220, Universitat de Barcelona. Espai de Recerca en Economia. [Downloadable!]
  8. Georges Dionne & Florence Giuliano & Pierre Picard, 2003. "Optimal Auditing for Insurance Fraud," Cahiers de recherche 0329, CIRPEE. [Downloadable!]
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