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Insurance Fraud and Optimal Claims Settlement Strategies

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  • 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.

Suggested Citation

  • Crocker, Keith J & Tennyson, Sharon, 2002. "Insurance Fraud and Optimal Claims Settlement Strategies," Journal of Law and Economics, University of Chicago Press, vol. 45(2), pages 469-507, October.
  • Handle: RePEc:ucp:jlawec:v:45:y:2002:i:2:p:469-507
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    File URL: http://dx.doi.org/10.1086/340394
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    References listed on IDEAS

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    1. Keith J. Crocker & John Morgan, 1998. "Is Honesty the Best Policy? Curtailing Insurance Fraud through Optimal Incentive Contracts," Journal of Political Economy, University of Chicago Press, vol. 106(2), pages 355-375, April.
    2. Rosenberg, D. & Shavell, S., 1985. "A model in which suits are brought for their nuisance value," International Review of Law and Economics, Elsevier, vol. 5(1), pages 3-13, June.
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    Cited by:

    1. Georges Dionne & Florence Giuliano & Pierre Picard, 2009. "Optimal Auditing with Scoring: Theory and Application to Insurance Fraud," Management Science, INFORMS, vol. 55(1), pages 58-70, January.
    2. Jean-Marc Bourgeon & Pierre Picard, 2014. "Fraudulent Claims and Nitpicky Insurers," American Economic Review, American Economic Association, vol. 104(9), pages 2900-2917, September.
    3. Helen I. Doerpinghaus & Joan T. Schmit & Jason Jia-Hsing Yeh, 2008. "Age and Gender Effects on Auto Liability Insurance Payouts," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 75(3), pages 527-550.
    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.
    5. repec:bla:jrinsu:v:84:y:2017:i:1:p:7-34 is not listed on IDEAS
    6. Kangoh Lee, 2012. "Uncertain indemnity and the demand for insurance," Theory and Decision, Springer, vol. 73(2), pages 249-265, August.
    7. Scalera Domenico & Zazzaro Alberto, 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, De Gruyter, vol. 7(1), pages 1-30, October.
    8. 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.
    9. Georges Dionne & Pierre-Carl Michaud & Maki Dahchour, 2004. "Separating Moral Hazard from Adverse Selection in Automobile Insurance: Longitudinal Evidence from France," Cahiers de recherche 0420, CIRPEE.
    10. Lu-Ming Tseng & Yue-Min Kang, 2015. "Managerial Authority, Turnover Intention and Medical Insurance Claims Adjusters’ Recommendations for Claim Payments," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 40(2), pages 334-352, April.
    11. David S. Loughran, 2005. "Deterring Fraud: The Role of General Damage Awards in Automobile Insurance Settlements," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 72(4), pages 551-575.
    12. Dana A. Kerr, 2005. "The Effect of Ownership Structure on Insurance Company Litigation Strategy," The Journal of Legal Studies, University of Chicago Press, vol. 34(1), pages 273-294, January.
    13. Jing Ai & Patrick L. Brockett & Linda L. Golden & Montserrat Guillén, 2013. "A Robust Unsupervised Method for Fraud Rate Estimation," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 80(1), pages 121-143, March.
    14. 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.
    15. Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.
    16. 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.
    17. Qin Lian & Harris Schlesinger, 2012. "Insurance Contract Design When the Insurer Has Private Information on Loss Size," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 79(4), pages 1039-1050, December.
    18. repec:spr:grdene:v:21:y:2012:i:5:d:10.1007_s10726-011-9241-y is not listed on IDEAS
    19. Bénédicte Coestier & Nathalie Fombaron, 2003. "L'audit en assurance," THEMA Working Papers 2003-41, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
    20. Katja Müller & Hato Schmeiser & Joël Wagner, 2016. "The impact of auditing strategies on insurers’ profitability," Journal of Risk Finance, Emerald Group Publishing, vol. 17(1), pages 46-79, January.
    21. 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.
    22. 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.
    23. repec:spd:journl:v:67:y:2017:i:2:p:69-84 is not listed on IDEAS

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