Processes combating criminal insurance fraud are working well, according to industry experts, but opportunistic fraud is much more problematic due to its roots in genuine claims and policy applications
In many ways, insurance is very black and white. Each policy will have its own terms and conditions, detailing precise elements of cover, while claims payouts are based on specifically sought after data points and information.
However, one undesirable facet of the market that plays decidedly in the grey is opportunistic fraud – where claims for genuine incidents may be exaggerated or risks misrepresented on policy applications in order for insureds to obtain what they view as more bang for their buck.
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