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Why do consumers perpetrate fraudulent behaviors in insurance?

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Abstract

Insurance fraud is an increasing problem with major financial, societal and humanitarian impact. Several disciplines have attempted to explain fraudulent behaviors in insurance perpetrated by consumers from economics to criminology and social psychology. Drawing on data from a national survey in Portugal, this study analyzed the levels of acceptance of and justifications underlying fraudulent behavior related to automobile, workplace accidents, and health insurance. Cluster analysis revealed two main groups of respondents with divergent positions: those who consider fraud unacceptable and unjustifiable vs. those who consider it normal and justifiable. A third cluster of respondents consider fraud generally unacceptable but justifiable when it attempts to restore justice. Results are discussed considering the importance of contractual, individual, relational as well as cultural and macrosocial factors in dealing with the complexity of consumers’ unethical behavior. We argue for an integrated approach to research and prevention of consumer insurance fraud.

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Notes

  1. In “Crash for Cash” fraud scams, fraudsters intentionally crash into other vehicles (of an innocent victim or of another fraudster) or use a sledgehammer (or other instruments) to imitate the effects of a crash in order to submit false claims.

  2. It is beyond the scope of this paper to review theoretical developments in consumer ethics research in general or processes of decision making in ethical issues in business, however, whenever appropriate, references to them may be made (see, for instance: [22,23,24,25,26,27]).

  3. ESS Round 5: European Social Survey Round 5 Data (2010). Data file edition 3.4. NSD - Norwegian Centre for Research Data, Norway – Data Archive and distributor of ESS data for ESS ERIC. doi:https://doi.org/10.21338/NSD-ESS5-2010.

  4. Building on the moral-sociological, moral-psychological, and contractual-economic approaches proposed by Tennyson [9], Lesch and Brinkmann [17] added two more: social construction and customer as co-creator.

  5. Other cognitive techniques have been showed to be linked to unethical behavior: moral re-construal, euphemistic labelling, advantageous comparisons, displacement, diffusion or denial of responsibility, attribution of blame, moral disengagement, disregard or distortion of consequences, dehumanization, denial of injury or of the victim, appeal to higher “loyalties” or “condemning the condemners” [22, 42, 44, 50,50,51,52,54].

  6. For a recent discussion about anomie and crime see DiCristina [65]. See also Merton’s work [66] about criminal behavior as an innovative response to the failure in attaining monetary success through institutional norms.

  7. Several studies have reported differences regarding ethical issues in insurance according to sociodemographic characteristics, namely sex [19, 20, 34, 56, 57, 82], age [19, 82], occupation [19, 82], education [19, 56], income [20, 56], etc. Since considering all combinations of categories would be extremely complex, sex and professional occupation were chosen considering the results of main empirical studies.

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Acknowledgements

This research was financed by the Portuguese Insurer Association (Associação Portuguesa de Seguradores - APS) and developed under the coordination of the Observatory of Fraud in Economics and Management (OBEGEF). Special thanks are due to the members of the technical teams of APS and OBEGEF for the valuable contributions in the development of the research and interpretation of results. A particular thank you is addressed to all those who commented on earlier versions of this paper, namely Alda Correia for her helpful suggestions and comments to the first draft, presented at the 3rd OBEGEF Conference, Interdisciplinary Insights on Fraud and Corruption – The Costs of Economic Crime, Claudia Abreu Lopes, and to the two anonymous reviewers. Usual disclaimers apply. This article was also possible due to the financial support of FCT - Portuguese Foundation for Science and Technology to Raquel Ribeiro (DL57/2016/CP1341/CT0030).

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Authors and Affiliations

  1. Center for Social Studies of the University of Coimbra (CES-UC), Colégio de S. Jerónimo, Largo D. Dinis, Apartado 3087, 3000-995, Coimbra, Portugal

    Raquel Ribeiro

  2. Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal

    Bruno Silva & Gabrielle Poeschl

  3. Centre for Psychology at University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal

    Bruno Silva & Gabrielle Poeschl

  4. School of Economics and Management of the University of Porto, Rua Dr. Roberto Frias, 4200-464, Porto, Portugal

    Carlos Pimenta

  5. Observatory of Fraud in Economics and Management, Rua Dr. Roberto Frias, 4200-464, Porto, Portugal

    Carlos Pimenta

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Ribeiro, R., Silva, B., Pimenta, C. et al. Why do consumers perpetrate fraudulent behaviors in insurance?. Crime Law Soc Change 73, 249–273 (2020). https://doi.org/10.1007/s10611-019-09857-2

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