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Focus and Features
The Philippine insurance industry continues to thrive with a resonating P1.56 trillion of total assets, P260 billion worth of premium income, and P320 billion of net worth in 2017, posting a double-digit increment as against 2016 figures. In the global landscape, emerging markets particularly China are gearing towards a rapid growth at least on a percentage basis while in the United States, nearly five million more US households had life insurance as of 2016 than in 2010 which is mainly fueled by population growth.
With billions and trillions of monies, the industry has become more and more attractive to individuals and organizations to commit fraud through varying schemes. In the country, total benefits payments and losses incurred amounted to P96.7 billion, an increase of 15% from 2016 that registered P84.1 billion. Definitely, there is a portion of this which is suspicious. Furthermore, it was mentioned that 10% of total motor car claims is estimated to be fraudulent although there are no figures to support this estimate.
Insurance fraud is definitely damaging the insurance industry. It is therefore necessary for insurers to lay down their anti-fraud mechanisms to mitigate the risk of exposure even if combatting insurance fraud is admittedly a challenging task. Insurance fraud is a complex matter and the allegation of which even leads to the courtroom and reaching as far as the Supreme Court.
What You Will Learn
Introduction
- Overview of the insurance industry and its business practices
- What is insurance fraud?
- The Philippine and Global experience on insurance fraud
- Insurance Commission (IC) Circular 2016-50 Guidelines in the development ofanti-fraud plans for insurance companies
Insurance Fraud Schemes
- Types and Examples of Insurance Fraud Schemes
- The Players in Insurance Fraud
- Red Flags of Insurance Fraud
Insurance Claim Investigation
- Special Investigation Unit (SIU): Its Role and Functions
- Investigation Procedures
Wrap-up
Who Should Attend
This course is intended to provide participants with an overview of insurance fraud and the possible ways of detecting it. Target participants include claims processors, underwriters, and personnel designated in an Insurer's Special Investigation Unit or its equivalent.
