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Insurance Fraud and Optimal Claims Settlement Strategies

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  • Crocker, Keith J
  • Tennyson, Sharon
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    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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    Bibliographic 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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    Web page: http://www.journals.uchicago.edu/JLE/

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    Cited by:
    1. Dionne, G. & Michaud, P.C. & Dahchour, M., 2004. "Separating Moral Hazard from Adverse Selection in Automobile Insurance: Longitudinal Evidence from France," Discussion Paper 2004-79, Tilburg University, Center for Economic Research.
    2. 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.
    3. G. Dionne & F. Giuliano & P. Picard, 2002. "Optimal auditing for insurance fraud," THEMA Working Papers 2002-32, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
    4. Domenico SCALERA & Alberto ZAZZARO, 2004. "From regulation to free market: the experience of the European motor insurance market," Working Papers 205, Universita' Politecnica delle Marche (I), Dipartimento di Scienze Economiche e Sociali.
    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.
    6. Schiller, Jörg, 2004. "Versicherungsbetrug als ökonomisches Problem: Eine vertragstheoretische Analyse," Working Papers on Risk and Insurance 13, University of Hamburg, Institute for Risk and Insurance.
    7. 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.
    8. 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.
    9. Bénédicte Coestier & Nathalie Fombaron, 2003. "L'audit en assurance," THEMA Working Papers 2003-41, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
    10. Kangoh Lee, 2012. "Uncertain indemnity and the demand for insurance," Theory and Decision, Springer, vol. 73(2), pages 249-265, August.
    11. Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.

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