DEVELOPMENT AND ANALYSIS OF MORAL-MATRIX METHODOLOGY FOR IDENTIFICATION OF POSSIBLE ELEMENTS LEADING TO MORAL HAZARDS IN INSURANCE CLAIM PROCESSES
Abstract
Insurance is an important domain that is necessary for everyone. Global businesses in the field of insurance support many verticals like health insurance, structural insurance, fire insurance, motor vehicle insurance, liability insurance, health insurance, aviation insurance, etc. As insurance is a security provision one can opt for. However, since history of insurance the fake claim process has been noticed prominently by insurance companies. The basis of such fake claims is moral hazard which deals with the psychological state of involved entities. Hence, this paper presents the fake insurance claim scenario-based identification of elements leading to moral hazard incidences by means of the proposed moral-matrix methodology. The proposed methodology considers three entities involving process parameters consumer, internal entity, and external entity, which are the pillars of ethical practices.
Keyword : Moral hazard, insurance, client behavior, claim validation, claim parameters, policy constraints, external entity
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References
[1] Afoakwah, C., Byrnes, J., Scuffham, P., & Nghiem, S. (2023). Testing for selection bias and moral hazard in private health insurance: Evidence from a mixed public‐private health system. Health Economics, 32(1), 3-24. [2] Xu, Z. Q. (2023). Moral-hazard-free insurance: mean-variance premium principle and rank-dependent utility theory. Scandinavian Actuarial Journal, 2023(3), 269-289. [3] Adachi, D., Nakata, H., Sawada, Y., & Sekiguchi, K. (2023). Adverse selection and moral hazard in corporate insurance markets: Evidence from the 2011 Thailand floods. Journal of Economic Behavior & Organization, Elsevier, 205, 376-386. [4] Holzapfel, J., Peter, R., & Richter, A. (2023). Mitigating moral hazard with usage-based insurance. Available at SSRN 4325478. [5] Tsipiras, K., & Grant, W. J. (2022). What do we mean when we talk about the moral hazard of geoengineering?. Environmental Law Review, 24(1), 27-44. [6] Molk, P. (2018). Playing with Fire: Testing Moral Hazard in Homeowners Insurance Valued Policies. Utah L. Rev., 347. [7] Annan, F. (2022). Moral hazard in insurance: Theory and evidence from a credit reform in Ghana. Journal of Public Economics, 209, 104633. [8] Igor, F. (2022). Selection on moral hazard in the Swiss market for mandatory health insurance: Empirical evidence from Swiss Household Panel data. arXiv preprint arXiv:2208.03815. [9] Wagner, K. R. (2022). Adaptation and adverse selection in markets for natural disaster insurance. American Economic Journal: Economic Policy, 14(3), 380-421. [10] Parchomovsky, G., & Siegelman, P. (2022). Third-Party Moral Hazard and the Problem of Insurance Externalities. The Journal of Legal Studies, 51(1), 93-131. [11] Zhu, J. N., Lam, L. W., Liu, Y., & Jiang, N. (2022). Performance Pressure and Employee Expediency: The Role of Moral Decoupling. Journal of Business Ethics, Springer, 1-14. [12] Óskarsdóttir, M., Ahmed, W., Antonio, K., Baesens, B., Dendievel, R., Donas, T., & Reynkens, T. (2022). Social network analytics for supervised fraud detection in insurance. Risk Analysis, 42(8), 1872-1890. [13] Nia, F. H., & Niavand, H. (2021). Review on application of data mining in insurance. SAARJ Journal on Banking & Insurance Research, 10(3), 24-30. [14] Remli, N., Salleh, F., & Arifin, J. (2021). Motor Insurance Fraudulent Claims: An Overview Reconnaissance. International Journal of Business, Economics, and Law. [15] Macedo, A. M., Cardoso, C. V., & Neto, J. S. M. (2021). Car insurance fraud: the role of vehicle repair workshops. International Journal of Law, Crime, and Justice, 65, 100456. [16] Galan-Ladero, M. M., & Robson, J. (2021). Unsocial and Irresponsible Behaviour: What Happens When Customers Lie? Taylor Francis Productivity Press, In Social and Sustainability Marketing (pp. 509-534).