engleski

Effective strategies for detecting fraudulent claims in motor third party liability insurance

Preventing, detecting and combating insurance fraud are major insurance problems. The author considers current framework combating insurance fraud. Noting on direct effect which insurance fraud have on collaps of the insurance system, the author analyzes finnacial losses that insurance fraud creates to the insurance industry (affecting on financial and market position of the insurance company) and the economy. The negative effects of insurance fraud are affecting the consumers – the most important factors of economic system since the financial losses developed as a result of insurance fraud carry honest policyholders by paying increased amount of insurance premiums. Pointing to the protection of the consumers economic interests as a fundamental european principles and application of the principle of good faith during the establishment and realization of the insurance relation rights, the author analyzes the legal effects of presenting fraudulent claims in Motor Third Party Liability (MTPL) insurance. In this work it was carried a comparasion of the Fraud indicators or Red Flags as a worning signs and fraud alerts of a suspicious insurance claims in USA and Europe. Presenting European origins compulsory MTPL insurance it was pointed to the significance of active and systematic fights against insurance fraud by signing the „Protocol on cooperation to combat insurance fraud“ from 2011 and integration of the Fraud Risk Assessment Form (FRAF) in the claim handling to identify potential fraudulent cases i.e. prove fraudulent insurance claims. Special attention is given in relation to fraudulent activity committed by policyholders - presenting fraudulent insurance claims and identifying irregular activity related to claimant according to FRAF.

FRAF ; MTPL insurance ; Red Flags

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