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Erklärungsansätze für vertragswidriges Verhalten von Versicherungsnehmern aus Sicht der ökonomischen Theorie

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  • Nell, Martin
  • Schiller, Jörg
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    Abstract

    Ziel dieser Arbeit ist es, in die ökonomische Analyse des Versicherungsbetrugs einzuführen und einige grundlegende Determinanten für vertragswidriges Verhalten von Versicherungsnehmern aufzuzeigen. Dazu werden zunächst die strategischen Entscheidungsprobleme von Versicherungsnehmern und Versicherern eingehend analysiert und optimales Verhalten unter realitätsnahen Annahmen hergeleitet, sowie Ansatzpunkte für die Betrugsbekämpfung aufgezeigt. Beispielhaft werden dazu die Auswirkungen von Betrugserkennungssystemen oder die konsequente Anzeige entdeckter Betrüger auf die Bekämpfung von Versicherungsbetrug näher untersucht. Es zeigt sich, dass beide Ansatzpunkte erheblichen Einfluss auf die Kosten des Versicherungsbetrugs haben können. Ein häufig geäußerter Kritikpunkt an solchen Analysen ist, dass ethische Bedenken der Versicherungsnehmer meist unberücksichtigt bleiben. Die Einbeziehung von ethischen Bedenken führt aber nicht zwangsläufig zu einer niedrigeren Betrugshäufigkeit. Abschließend wird der Frage nachgegangen, inwieweit Versicherungsbetrug auf versicherungsspezifische Faktoren zurückzuführen ist und wie bzw. in welchem Umfang Versicherer Einfluss auf die ethische Bewertung des Versicherungsbetrugs durch Versicherungsnehmer nehmen können. -- The two main purposes of this paper are an introduction to the economic analysis of insurance fraud and furthermore a derivation of factors that determine fraudulent behavior of policyholders on insurance markets. Consequently, we analyze the strategic decision problems of insurance companies and the policyholders and identify some factors that can help to reduce fraudulent behavior. In this context we evaluate two derived starting points for the combat against insurance fraud: fraud detection systems and a consequent charge policy of detected defrauders. We illustrate that both points can help to reduce the cost of fraud. Furthermore, we enhance our earlier analysis with respect to the empirical fact that some individuals care about fairness or - in the insurance fraud context - the legitimacy of their actions. Surprisingly, in some market situations these concerns of some policyholders do not lead to a lower fraud probability. Finally, we discuss how and to what extent insurance companies can influence such ethical concerns of policyholders. On that score, we distinguish insurance specific and insurance unspecific factors and their impact on the consumers attitudes towards insurance fraud.

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    Bibliographic Info

    Paper provided by University of Hamburg, Institute for Risk and Insurance in its series Working Papers on Risk and Insurance with number 7.

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    Date of creation: 2002
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    Handle: RePEc:zbw:hzvwps:7

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    1. Ernst Fehr & Klaus M. Schmidt, . "A Theory of Fairness, Competition and Cooperation," IEW - Working Papers 004, Institute for Empirical Research in Economics - University of Zurich.
    2. Mookherjee, Dilip & Png, Ivan, 1989. "Optimal Auditing, Insurance, and Redistribution," The Quarterly Journal of Economics, MIT Press, MIT Press, vol. 104(2), pages 399-415, May.
    3. Ingela Alger & Ching-to Albert Ma, 2001. "Moral Hazard, Insurance, and Some Collusion," Boston College Working Papers in Economics, Boston College Department of Economics 496, Boston College Department of Economics.
    4. Marie-Cécile Fagart & Pierre Picard, 1999. "Optimal Insurance Under Random Auditing," The Geneva Risk and Insurance Review, Palgrave Macmillan, vol. 24(1), pages 29-54, June.
    5. Kai Sülzle & Achim Wambach, 2005. "Insurance in a Market for Credence Goods," Journal of Risk & Insurance, The American Risk and Insurance Association, The American Risk and Insurance Association, vol. 72(1), pages 159-176.
    6. Picard, Pierre, 1996. "Auditing claims in the insurance market with fraud: The credibility issue," Journal of Public Economics, Elsevier, Elsevier, vol. 63(1), pages 27-56, December.
    7. Townsend, Robert M., 1979. "Optimal contracts and competitive markets with costly state verification," Journal of Economic Theory, Elsevier, Elsevier, vol. 21(2), pages 265-293, October.
    8. Tennyson, Sharon, 1997. "Economic institutions and individual ethics: A study of consumer attitudes toward insurance fraud," Journal of Economic Behavior & Organization, Elsevier, Elsevier, vol. 32(2), pages 247-265, February.
    9. M. Martin Boyer, 2000. "Centralizing Insurance Fraud Investigation*," The Geneva Risk and Insurance Review, Palgrave Macmillan, vol. 25(2), pages 159-178, December.
    10. Fahad Khalil, 1997. "Auditing Without Commitment," RAND Journal of Economics, The RAND Corporation, vol. 28(4), pages 629-640, Winter.
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