Factors Affecting Insurance Fraud: An Overview Study Based on Adam's (1965) Equity Theory

Uncovering insurance fraud used to be a resource-intensive, arduous, and expensive process, while claims agents had to rely purely on statistical models to identify fraudulent claims, thus increasing the likelihood that fraud would go undetected. Fraud increases insurance costs, threatens the financial strength of insurance companies, and negatively affects the availability of insurance. A cursory review of the insurance fraud literature reveals little scholarly information. In the insurance industry, customers' perceived fairness is an important issue because it has been found that unfair treatment by an insurance company (e.g., a fair amount of deductible) may increase the customer's intention to commit insurance fraud. For example, research by Miyazaki (2009) [16] shows that the deductible amount affects the policy owner's perception of whether the claim is acceptable. On the contrary, an unfair distribution of outcomes can lead to very negative consequences. Therefore, service providers strive to increase customers' perception of fairness to maintain and develop their services (Sindhav et al., 2006) [20]. This study aims to explain and analyze these factors. Factors influencing the intention to commit insurance fraud in the health care insurance sector based on the synthesis of research and providing some policy implications for Vietnamese insurance businesses in the current context.