Claims fraud is a large-scale problem for the insurance industry, but it is important for insurers to differentiate between “opportunistic” fraud and “organized” fraud. Opportunistic fraud is sporadic fraud activity, often occurring on a one-time basis. Such fraud may involve exaggeration of a claim to make up for losses under a deductible.

In a large-scale survey conducted in 2010, Accenture examined consumers’ attitudes toward insurance fraud and those who commit it. The company found that, among other factors, poor service is a major contributor to opportunistic fraud. The results suggested that more than half of U.S. adults believe that poor service from an insurer is more likely to cause an individual to commit fraud against that company.

The survey also indicated, encouragingly, that consumers themselves still find insurance fraud unacceptable. Only 12 percent of U.S. adults surveyed said they believe it is acceptable to overstate the value of an insurance claim, while five percent approved of submitting claims for items that have not actually been lost or damaged—or for treatments or services not received. 

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