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| Chapter: 1-5
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STUDY OF THE DETECTION AND CHECKS OF CLAIMS FRAUD IN THE INSURANCE INDUSTRY
A study of the detection and checks of claims fraud operation starts from the propose insured who offers a business contract to the insurer by completing the proposal form questions with appropriate answers.
The insurer on the often hard inspect the paid of the insured before the insured could course for the settlement of claims and the policy holder should come for the claim, immediately the loss has been sustained.
The insured will notify and clear his mind from fraudulent company in other to enter for a legal contract with the insurance company. The other hand of the detection body the insurer and the insured will so into inspection before any risk could be settled more so the policy evidence of contract between the insured and the insurer and it is well established in law that general wile of contention and interpretation shall apply to insurance contracts as well as to other contacts. Checking operation the insured show his responsibilities in enlightening the insured how a risk or peril should be avoided and rather imp wired the policy holders risks.
The objectives of this project is to study the detection and checks of claims fraud most especially in Nigeria because of the ill educated people in Nigeria who could not enter into insurance policy because they be live that God will insure them conclusion all the insurance companies should take steps in ensuring the wording of the policy are bodily written so that one would not need to strain the eyes before being able to read through the lines of printed words and they should consider the use of simple and understandable English language while drafting the policy. Ambiguous terms should not be used. Appropriate sales production scheme or advertising channel must be taken.
1.1 BACKGROUND OF STUDY
The study of the detection and checks of claims fraud in the Nigerian insurance firm or institution and the causes also the solution. Insurance claim arise when a loss occurred. In the occurrence of loss. He insured is expected notify the insurer immediately the loss occurred. The insurance should then forward a claim form to the Clurman the insurance also open a file end register, carefully investigation are carried out on the issue of the loss before the claims could be settled. It can either be by cash, repaint replacement or reinstatement depending on the method providing for as agreed at the method providing for as agreed at the inception of the contract
Fraud is also as defecation. It is means the act of making some entries in other to misappropriate some goods or money, such approach may be performed by an individual or group of individuals without the knowledge of the management committee with the intention to of defrauding the insurance company.
It can curse when claim fraud is detected from fictitious payment in the cashbook or stock records, in the case of goods. It has increased in size and used in obtaining great sophisticated by the day.
Currently with the introduction of modem insurance method automatic electronic gadget communication system and computer into the insurance industry frauds have already taken a different shape and some involved increase rapidly in an obstacle to growth of insurance industry. It was discovered during investigation, broker now take extra care before clearing claim due to rampant cases of fraud and forgery in which or insurance company Bose placed on the head in Nigeria. Fraud has become sophisticated as to make forged claim so that insurance company will agree to compensate the insured.
In a bid to reduce the occurrence and size of fraud in Enugu state insurance company. The insurance workers now take adequate measures before settling or indemnifying a claim. These measures bring into causes of delay in claim settlement.
The reason for this researcher work is to identify the study of the detection and checks of claims fraud in insurance companies in Enugu state, Nigeria have recommended more important or vital measures that will help in the controlling of frauds in insurance company.
1.2 STATEMENT OF THE PROBLEM
Insurance company has played a special role to the society but there are many problems facing the company.
i) Ill educated people in the society due to the high illiteracy in our society makes the insurance to have difficult problem enlightening them how to improve their risk
ii) Government not looking into insurance company problems and providing them with adequate facilities for the detecting of fraud.
iii) The police insured and claim investigator working in hand to defraud the insurance company.
iv) The insurance officials refuse to give enough information due to bias mind to defraud the insurance company.
1.3 OBJECTIVES OF THE STUDY
The researcher having successfully indicated the numerous problems obtained on insurance claim fraud in insurance institution will now state the purpose of carrying research work.
i) To eliminate various types of claims fraud.
ii) To determine the causes of fraud in insurance industry.
iii) To observe if there legal loopholes. In Nigeria legal system that encourage frauds.
iv) Determination of control measure and strategies against fraud and making of vital recommendation.
1.4 SIGNIFICANCE OF THE STUDY
The system used in checking these fraud and insurance claim acquire greater sophistication by the day. As insurance company in Enugu state are busy finding the way of controlling fraud and settling claims, the fraudsters in connection with some dishonest insurer device new system of doping or robbing the company.
In addition, it should be noted that the results of these ugly cases are damaging
i) Fraud brings about unwanted losses for an insurance company and equally put the management on a confused state of mind while spending hard-neared resources on fraud control.
Any case of insurance company clips off a bit of public trust in financial institution and well so down the development of banking habits.
Moreover, it can easily be noticed that if nothing is done to control these ugly incidence fraud could lead to the total collapse of the economy.
Thus researcher tend to look into this research work the major of the detection and checks of claims have with intention to provide suitable recommendation that will help in fraud control and insurance claims.
1.5 SCOPE AND LIMITATION OF THE STUDY
This work entitle the detection and checks of claims fraud, but for the purpose of this research work, it has been shorten down to contain only the miscuing of claims and fraud also it could be checked the problems encountered by the insurance company when carrying out the work of the study of the detection of claims fraud. The objectives of the detection and checks of claim fraud. The firm also cover the areas of raising defrauding claims and checks in an insurance institution in Enugu state.
These use factors that limit or affect the research during the research work. Some of them are on follows.
1. Time factor
2. lack of fund
3. Weather condition
4. lack of good network of wad
5. lack of power
6. lack of data
Time factor: during the work there was no enough time to conduct the study in order to make the topic researchable.
Lack of fund: This acted as obstacle during the project work, during the time of the research there were no enough fund to visit some place for data collection
WEATHER CONDITION: Due to the fact that we are on rainy season. It was not all that possible to go to many places for data collection.
LACK OF GIXID NETWORK OF ROAD: The roads are not well linked up and most of them are bad that one not drive through daring data collection.
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