英国の保険料支払請求における問題点：2007年

Abstract

Overview

Introduction

Claims management lies at the very centre of the insurance industry, and processing claimants efficiently is perhaps the biggest challenge that providers face. The balance between claim validation and customer satisfaction complicates the process making cost containment difficult.

Scope

• An evaluation of claims costs containment strategies
• Analysis of the current trends in fraud and anti-fraud systems
• Discussion of the latest regulatory developments affecting claims

Report Highlights

The ABI estimated that personal lines fraud was directly costing the insurance industry up to £1.6 billion a year in 2006. This additional outlay was passed onto the consumer which increased premiums by an average of 5 per cent.

With many large insurers having numerous legacy systems to handle claims, it has benefited some insurers to rely upon contractors to provide IT solutions. Specialized companies in the claims management industry have made numerous investments in technology that can provide the up-to-date IT backbone for the claims process and so generate savings.

Reasons to Purchase

• Gain insight into strategies insurers are adopting to combat claims inflation.
• Benefit from an examination of the impacts regulation and legal changes have had on claims management.
• Develop your future strategy to deal with changes occurring in UK claims management

Table of Contents

• Overview
  • Catalyst
  • Summary
• Executive Summary
  • Third party injury, escape of water and flood claims are driving up the claims bill
  • Insurers are piloting several programs that aim to reduce medical and repair claims costs
    • Recycled parts allow insurers to be green and lower the claims bill
    • Early rehabilitation lowers treatment costs and generates cost savings for insurers
  • Insurers have used supply chain management to curb the growth of claims bills
    • Procurement agreements have become standard mainly due to savings from economies of scale
  • Outsourcing has a number of advantages and disadvantages
    • Outsourcing can allow an insurance provider to quickly adopt the benefits of new technology without the cost
    • Cost saving continues to dominate the debate over the use of outsourcing, although attitudes are changing
  • Fraud continues to cost insurers up to £1.6 billion a year
    • While organized crime is behind some of the larger insurance fraud cases, opportunistic fraud accounts for the majority of fraud cases
    • Crash for cash schemes remain a significant source of fraudulent motor claims committed by organized crime
    • Opportunistic fraud remains difficult to detect, though widespread
  • Insurance providers have a number of techniques at their disposal to combat fraud
    • Measures that detect fraudulent cases early on are key in keeping fraud costs contained
  • Claims management has been impacted by a great deal of changes to the regulatory framework it operates in
    • New fire regulations may increase the cost of property insurance claims
    • New NHS Injury Costs Recovery Scheme regulations came into effect in January 2007
    • The DCA paper on damages has the potential to stoke claims inflation for personal injury cases
    • There may be changes to regulations surrounding third party capture and periodic payments
      • The FSA may move to regulate the use of third party capture by insurers
      • Periodic payments have failed to have the impact many feared, though can lead to higher claims costs
• Table of Contents
• Table of figures
• Table of tables
• Chapter 1 Introduction
  • What is this report about?
  • Who is the target reader?
• Chapter 2 Claims Costs
  • Introduction
  • Third party injury, escape of water and flood claims are driving up the claims bill
    • Each line has similar claims cost drivers
    • Third party injury remains the top driver behind claims costs
    • Property insurers are seeing an increase in escape of water and flood related claims
  • Insurers are piloting several programs that aim to reduce medical and repair claims costs
    • Recycled parts allow insurers to be green and lower the claims bill
    • Early rehabilitation lowers treatment costs and generates cost savings for insurers
      • Research indicates that rehabilitation can generate savings
      • More insurers are moving to early and standard rehabilitation
    • IT investments are key to realizing cost reductions and speeding up claims handling
      • The Lloyd' s market has set the target of December 2007 to have all claims handled electronically
      • Claims management software has proliferated with many specialized applications but insurers must be careful to not simply add more systems to the mix
      • Insurers do not always have to make the investments in IT themselves to benefit from improved claims management software
• Chapter 3 Supply Chain Management and Outsourcing
  • Introduction
  • Insurers have used supply chain management to curb the growth of claims bills
    • Procurement agreements have become standard mainly due to savings from economies of scale
      • Fraud can be reduced by the use of replacement-in-kind and store vouchers, while reputation increases
    • Supply agreements have their drawbacks as customer service can suffer if the relationship is not carefully managed
  • Outsourcing has a number of advantages and disadvantages
    • Outsourcing can allow an insurance provider to quickly adopt the benefits of new technology without the cost
    • Cost saving continues to dominate the debate over the use of outsourcing, although attitudes are changing
    • Outsourcing in the insurance sector is not as prominent as in other financial services markets, but is still a key part of many insurers' strategies
    • Lack of control over the claims process has kept some insurers from outsourcing any claims handling
    • The leaders in outsourced claims management have made strides in the market
      • Capita made a number of acquisitions and new business launches in 2006 and 2007
      • Cunningham Lindsay
      • Crawford and Company
• Chapter 4 Anti-Fraud Developments
  • Fraud continues to cost insurers up to £1.6 billion a year
    • While organized crime is behind some of the larger insurance fraud cases, opportunistic fraud accounts for the majority of fraud cases
    • Crash for cash schemes remain a significant source of fraudulent motor claims committed by organized crime
    • The IFB has been very active in the investigation of professional fraud over the year it has been in operation
    • Opportunistic fraud remains difficult to detect, though widespread
  • Insurance providers have a number of techniques at their disposal to combat fraud
    • Measures that detect fraudulent cases early on are key in keeping fraud costs contained
      • Rapid medical assessment can deter suspect claims from proceeding, as well as providing good customer service
      • Fraud detection systems can provide real time validation of claims, detecting the fraud early on
    • Investments in IT are crucial in obtaining savings on claims costs and can improve customer services
      • Even simple IT solutions can benefit insurers in their bid to contain fraud costs
      • There are a number of providers of more sophisticated anti-fraud measures operating in the market
    • Publicity can significantly improve the effectiveness of anti-fraud measures as well as provide its own deterrent
    • Follow up on the initial claims can often uncover and deter fraud claims
    • Insurance providers are identifying and preventing more fraud, suggesting anti-fraud efforts are producing dividends
• Chapter 5 Regulation and Law
  • Introduction
  • New fire regulations may increase the cost of property insurance claims
    • New fire regulations came into effect in October 2006
    • Total losses have increased, with insurers noticing more large fire losses in 2006
  • New NHS Injury Costs Recovery Scheme regulations came into effect in January 2007
    • The NHS expects to recover an additional £150 million a year through the new cost recovery scheme
    • Cost recovery limits have increased to £38,000
    • Insurers fear current limits could be scrapped altogether within the next five years, increasing claims inflation even more
  • The DCA paper on damages has the potential to stoke claims inflation for personal injury cases
    • New Ogden tables and changes in the drivers of claims inflation could cause significant increases in personal injury costs
    • The DCA paper also recommended that the number of people eligible to claim damage payments for care and dependency be increased
  • There may be changes to regulations surrounding third party capture and periodic payments
    • The FSA may move to regulate the use of third party capture by insurers
    • Periodic payments have failed to have the impact many feared, though can lead to higher claims costs
  • The Compensation Act proved to be a mixed bag for claims managers with both benefits and drawbacks
    • Joint and several liability for mesothelioma cases was established in the Compensation Act of 2006, returning the status quo
    • Rehabilitation may become more attractive as a means for controlling costs because of the apology clause
    • Claims management companies must now be registered and comply with the new Compensation Act
• APPENDIX
  • Further reading
  • Future reading
  • Ask the analyst
  • General insurance research and analysis team
  • Datamonitor consulting
  • Disclaimer
  • List of Tables
    • Table 1: Estimated regional breakdown of ' crash for cash' scams since 1999, 2007
    • Table 2: Insurers contributing and subscribing to the CUE database, 2007
  • List of Figures
    • Figure 1: The Irish anti-fraud advertising campaign has been successful at reducing the incidence of fraud