Erklärungsansätze für vertragswidriges Verhalten Versicherungsnehmern aus Sicht der ökonomischen Theorie

The two main purposes of this paper are an introduction to the economic analysis of insurance fraud and furthermore a derivation of factors that determine fraudulent behavior of policyholders on insurance markets. Consequently, we analyze the strategic decision problems of insurance companies and the policyholders and identify some factors that can help to reduce fraudulent behavior. In this context we evaluate two derived starting points for the combat against insurance fraud: fraud detection systems and a consequent charge policy of detected defrauders. We illustrate that both points can help to reduce the cost of fraud. Furthermore, we enhance our earlier analysis with respect to the empirical fact that some individuals care about fairness or — in the insurance fraud context — the legitimacy of their actions. Surprisingly, in some market situations these concerns of some policyholders do not lead to a lower fraud probability. Finally, we discuss how and to what extent insurance companies can influence such ethical concerns of policyholders. On that score, we distinguish insurance specific and insurance unspecific factors and their impact on the consumers attitudes towards insurance fraud.     

Aspekte einer Neugestaltung des Rechtes der Versicherungsvermittlung

The current fundamental reform of the German insurance law cannot and will not stop short of the law of insurance mediation. Up to now Sec. 43 to 48 Versicherungsvertragsgesetz (VVG = German Insurance Act) govern only one type of insurance intermediary known as insurance agent. The act only sets up rules to which extent the insurance agent has authority to bind the insurer. In the way the law is construed by the courts it differs in many aspects from the written law. Thus it is suggested to define the generic term ?insurance intermediary“ in the act as well as the subcategories ?insurance broker“ and ?insurance agent“, whereby the term ?insurance agent“ also includes the field staff employed by an insurer. In connection with the diffi-cult distinction between insurance brokers and insurance agents it remains questionable on which type of intermediary the rules regulating the relationship between agents and insurants and thereby protecting the potential customers should be applied accordingly. This controversial and in practice significant question should be explicitly decided by the legislator for reasons of legal certainty. In so far Sec. 43a of the Austrian Insurance Act could act as a model function. Regarding the insurance agents’ authority to receive (Empfangsvertretungsmacht des Versicherungsvertreters) for the insurer propositions exist to explicitly declare Sec. 43 No.l VVG, which grants the agent the authority to receive when accepting a contractual offer for the insurer, as mandatory. This suggestion would be in accordance with the current case law. Furthermore the wording of Sec. 43 No.l VVG should be altered so that the insurants’ pre-contractual risk-notifications, which the prevailing opinion already regards as being included, is explicitly mentioned. In principle Sec. 43 No.2 WG, which grants the agent the authority to receive notifications and representations for the duration of the insurance contract, should be declared as mandatory, too. Exempted should be the authority to receive for dispositions regarding the entitlements to benefits from (life) insurance contracts and the right to receive the insured sum. Sec. 44 WG, which strongly restricts the attribution of the agent’s knowledge to the insurer, is unconvincing, especially from a legal policy point of view. Therefore it is to be cancelled without substitution. Finally the legislator should refrain from codifying the customary liability based on the principles of reliance.     

Zwischen Vertragstreue und Vorteilsstreben

In the context of this article the author states that the present law situation is quite sufficient, in order to fight frauds within the insurance range effectively. In his personal view it is missing however at general consciousness that such frauds represent criminal injustice. In all other respects the author demands the attitude of the insurance industry to bring already detected criminal offences also to criminal pursuit.     

Zur Nachhaltigkeit der Generationenverträge: Eine Diagnose der Kranken- und Pflegeversicherung

Employing the generational accounting approach, this paper analyses the stance of fiscal policy in Germany. We find that fiscal policy is presently not sustainable, which is mainly due to pay-as-you-go financed social insurance systems. In order to illustrate the relative impact, we isolate the Public Health Insurance and the Public Long Term Care Insurance. Our findings suggest that without radical reforms the implicit debt burden for future generations might reach a magnitude of more than two times the annual GDP and contribution rates to both schemes will explode during the next three decades.     

Artificial life

E-business processes between insurance companies and their private customers allow — in comparison to conventional business processing — savings in administrative expenses up to 30 per cent. However, today’s e-business processes are often described as little transparent and stereotyped. Users, therefore, complain them being far to complex and, as a consequence, do not accept them. Relating to research in the field of customer behaviour, it has been proved that even in e-business processes customers like to be contacted and treated individually. This can be reached by corresponding to the cognitive ability and the personal involvement of each customer. By using those mechanisms information processing becomes ?hospitable‘ or even ?human-alike‘. Chatter-bots simulate human behaviour in e-business processes and will possibly replace personnel in certain areas. Therefore, chatter-bots seem a suitable instrument to introduce successfully e-business processes between insurance companies and their private customers. Two positive consequences could be reached: first, process efficiency could be raised and second, cost-savings in processing could be gained.