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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.

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