Understanding the fraud
behavior?
“Crime never forgive the murderer” (V. Hugo)
Madalin Rosu
Responsible of Motor Insurance Section
Munich, March 2015
6 figures on Romanian insurance market
GWP
~1,9 billion euro
Non Life GWP
~1,5 billion euro
Motor share in NL
70%
MTPL share in NL
43%
MTPL combined ratio 117%
Bodily Injuries
* FSA press release at 9 months 2014
*
25% from all claims payments in MTPL
5 more figures on Romania
Population
~21,3 milions
Drivers (licenced)
~8,8 milion
Number of cars
~ 6 milion
Cars ratio
220 cars / 1000 inhabitants
Deaths in accidents ~ 5 / day
* Romanian Police Report for 2013
Behavior scheme
We need to concentrate our
focus on the big ball.
E
B
T
In order to better
understand big ball we need
to understand as well it’s
creation.
This equation is valid on any
person.
Behavior understanding
People are rather judging others in
order not to be themselves judged first
(A. Camus)
Do you have enough information's
and skills to “create” a false claim,
would you do it ?
Did you experienced in your activity an
interview with a fraudster and convince
him to renounce to the claim ?
What are the first thoughts that you
have on your mind when first question
was addressed to you?
Is not the answer the most important but
the feeling that you associate with.
All individuals are using the same pattern
(E+T=B). The most important is to identify
what type of E or T is important and
valuable for him/ her.
Behavior understanding
Claim value = 9.000 eur
Help !
“Laws are like spider nets through
which the big flies are passing but the
small flies get stuck” (H. Balzac)
What are the chances
for a “successful fraud”
without some hints ?
Helpers :
Broker, agent, employee,
claim handler, manager,
authority, politic etc.
Help
No
help
What about help?
Mirror of car at claim moment
different than insurance
Car at insurance it is perfect new
from showroom . Tires have
specific sign as from factory.
What about help?
Different
exhaust silencer
and missing
parking sensors
Plate number has
specific signs
which appear only
in case of risk
inspection
What about help?
One year and a half later
Same car (VIN) CASCO insured with 2nd Insurer
Pictures are taken on risk inspection moment
Sum Insured – 20.000 euro
Two years later in another insurer 2nd
Claim value ~ 8.000 euro
Regress on other insurer 3rd
Total loss – Fire
Claim paid by 1st insurer
Placebo effect in fraud fighting
Human mind is functioning in a very
interesting way especially when you
as a person start to risk something…..
Going back to the E+T=B, just simply
deliver a very strong information by
mistake while fraudster is near by and
you implement already the T in the
equation.
Invest time to observe and make notes.
Behavior is changing and emotions will
show what is need to be demonstrated
Placebo can be used in a huge variety of versions. On the organized crime groups
this should be adapted or even not used.
Placebo and behavior observation
Groupama 07 Nov
Euroins 26 Oct
Generali 20 Nov
Uniqa 22 Sep
Asirom- 07 Nov
Technology vs human
Responsibility allocation – teams, cooperation
•
Which one to be first filter?
Information exchange – internal, external
Prevention – UW, client scoring
•
•
What will be the level of training to
the claims technicians
What will be the next phase in fraud
when technology will prepare
Processes for identification, demonstration
Tools for identification, demonstration
Incentives
Training
Plans for development - all main LOBs
What to do !
Best practice –
Develop specific particular plans to cover gaps to best
practices.
Regular knowledge sharing within the actors in the market– deep dive into
specific topics
Tools – contributive negligence, success sharing – court
acts&argumentation&litigation, overall calibration of approach (BI specialized
lawyers, special type of claims)
Expert level - Support community of experts – structured info exchange,
quick problems resolution, support circulation of know how within companies in
the market.
Observe, understand and create models and patterns.
Thank you for your attention !
Madalin Rosu