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Insurance Fraud Estimation: More Evidence from the Quebec Automobile Insurance Industry

Author

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  • Caron, Louis

    (HEC Montreal, Canada Research Chair in Risk Management)

  • Dionne, Georges

    (HEC Montreal, Canada Research Chair in Risk Management)

Abstract

This article follows a previous study on insurance fraud in the Quebec automobile insurance industry (Dionne and Belhadji, 1996). Results from that research showed that 3 to 6.4% of all claim payments (excluding those for "glass damage only") contained fraud, representing 28 to 61 million dollars in 1994-1995. This evaluation was a minimum since it was limited to observed fraud only. In this paper, we apply a statistical method to estimate the total fraud level in the industry for the same period. Our results show a multiplicative factor of 3.4% of fraudulent files found in Dionne and Belhadji, which means that total fraud payments ranged from 96.2 to 208.4 million dollars in 1994-1995. Our Best Guess Estimator yields roughly a 10% fraud rate or about 113.5 million dollars. An interesting corollary in this finding is that the claim adjusters who participated to the survey (representing 70% of the market), observed only 1/3 of the potential frauds in the studied closed files. One can interpret this number as an index of efficiency for the entire verification process in the industry. A natural question is: Why is this index of efficiency so low?

Suggested Citation

  • Caron, Louis & Dionne, Georges, 1997. "Insurance Fraud Estimation: More Evidence from the Quebec Automobile Insurance Industry," Working Papers 96-2, HEC Montreal, Canada Research Chair in Risk Management.
    • Handle: RePEc:ris:crcrmw:1996_002
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    References listed on IDEAS

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    1. Dionne, Georges & St-Michel, Pierre, 1991. "Workers' Compensation and Moral Hazard," The Review of Economics and Statistics, MIT Press, vol. 73(2), pages 236-244, May.
    2. J. David Cummins & Sharon Tennyson, 1992. "Controlling Automobile Insurance Costs," Journal of Economic Perspectives, American Economic Association, vol. 6(2), pages 95-115, Spring.
    3. Picard, Pierre, 1996. "Auditing claims in the insurance market with fraud: The credibility issue," Journal of Public Economics, Elsevier, vol. 63(1), pages 27-56, December.
    4. Dionne, G. & St-Michel, P. & Vanasse, C., 1989. "Moral Hazard, Optimal Auditing And Workers' Compensation," Cahiers de recherche 8941, Centre interuniversitaire de recherche en économie quantitative, CIREQ.
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    Citations

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    Cited by:

    1. Dionne, Georges, 2012. "The empirical measure of information problems with emphasis on insurance fraud and dynamic data," Working Papers 12-10, HEC Montreal, Canada Research Chair in Risk Management.
    2. Dionne, Georges & Gagné, Robert, 1997. "The non-optimality of deductible contracts against fraudulent claims: an empirical evidence in automobile insurance," Working Papers 97-5, HEC Montreal, Canada Research Chair in Risk Management.
    3. Donatella Porrini, 2002. "Frodi nell'assicurazione RC Auto: analisi economica e possibili rimedi," Rivista di Politica Economica, SIPI Spa, vol. 92(2), pages 109-138, March-Apr.
    4. Dionne, Georges, 2000. "The Empirical Measure of Information Problems with Emphasis on Insurance Fraud," Working Papers 00-4, HEC Montreal, Canada Research Chair in Risk Management.
    5. Dionne, Georges & Gagne, Robert, 2002. "Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance," Journal of Risk and Uncertainty, Springer, vol. 24(3), pages 213-230, May.
    6. M. Martin Boyer, 2007. "Resistance (to Fraud) Is Futile," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 74(2), pages 461-492, June.
    7. Dionne, Georges, 1998. "La mesure empirique des problèmes d’information," L'Actualité Economique, Société Canadienne de Science Economique, vol. 74(4), pages 585-606, décembre.
    8. Herweg, Fabian & Müller, Daniel, 2008. "The Optimality of Simple Contracts: Moral Hazard and Loss Aversion," Bonn Econ Discussion Papers 17/2008, University of Bonn, Bonn Graduate School of Economics (BGSE).
    9. Lang, Matthias & Wambach, Achim, 2013. "The fog of fraud – Mitigating fraud by strategic ambiguity," Games and Economic Behavior, Elsevier, vol. 81(C), pages 255-275.
    10. Cohen Alma, 2006. "The Disadvantages of Aggregate Deductibles," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 6(1), pages 1-28, April.
    11. Chu-Shiu Li & Chwen-Chi Liu & Sheng-Chang Peng, 2013. "Expiration Dates in Automobile Insurance Contracts: The Curious Case of Last Policy Month Claims in Taiwan," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 38(1), pages 23-47, March.
    12. Lammers, Frauke & Schiller, Jörg, 2010. "Contract design and insurance fraud: An experimental investigation," FZID Discussion Papers 19-2010, University of Hohenheim, Center for Research on Innovation and Services (FZID).
    13. Frauke von Bieberstein & Jörg Schiller, 2018. "Contract design and insurance fraud: an experimental investigation," Review of Managerial Science, Springer, vol. 12(3), pages 711-736, July.
    14. Akın, Zafer, 2023. "Direct lying or playing the victim? An experimental study," Journal of Economic Behavior & Organization, Elsevier, vol. 216(C), pages 150-169.
    15. Akin, Zafer, 2022. "Playing the victim behavior: an experimental study," MPRA Paper 115532, University Library of Munich, Germany.
    16. Georges Dionne & Robert Gagné, 2001. "Deductible Contracts Against Fraudulent Claims: Evidence From Automobile Insurance," The Review of Economics and Statistics, MIT Press, vol. 83(2), pages 290-301, May.
    17. 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.
    18. Richard Watt, 2003. "Curtailing Ex-Post Fraud in Risk Sharing Arrangements," European Journal of Law and Economics, Springer, vol. 16(2), pages 247-263, September.
    19. Stijn Viaene & Guido Dedene, 2004. "Insurance Fraud: Issues and Challenges," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 29(2), pages 313-333, April.
    20. 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.

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    More about this item

    Keywords

    Insurance fraud; Quebec automobile insurance industry; observed fraud; estimated fraud; hidden phenomenon; claim adjusters; count data estimators; robustness;
    All these keywords.

    JEL classification:

    • D81 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Criteria for Decision-Making under Risk and Uncertainty
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies

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