Insurance fraud is a major concern to insurers because it reduces insurer profits and raises policyholders’ premiums. Moreover, insurance fraud is a crime against society. Insurance fraud can best be defeated by investigators who understand certain fundamental insurance principles, like first-party versus third-party coverage, insurable interest, policy interpretation, and bad faith.

This course provides an overview of insurance fraud—what it is, how it is perpetrated, and how it should be addressed. The course explains the many and varied types of fraud and offers insight into how insurers can best confront the issue. Also covered are the fundamental principles associated with investigating insurance fraud. The course explains how appropriate and ethical behavior by an insurer and its representatives leads to success, while ethical breaches and fraudulent actions can create problems.

Upon completion of this course, students should be able to

• understand the nature, significance, and prevalence of insurance fraud;
• distinguish among various types of insurance fraud;
• recognize fundamental principles that are important when investigating insurance fraud; and
• distinguish between ethical and unethical behavior expected of various parties to the insurance transaction, especially with respect to claims handling.