Issue: № 6, 2026
Doi: https://doi.org/10.37634/efp.2026.6.10e
Introduction. Insurance fraud is one of the most common types of economic offenses that has accompanied the development of insurance relations over a long historical period. Its spread negatively affects the financial stability of insurance companies, violates the principles of fair distribution of insurance risks, and creates an additional burden on bona fide participants in insurance relations. The purpose of the paper is to study insurance fraud, reveal its characteristic features and ways of manifestation, as well as find ways to combat financial abuse in the insurance sector. Results. The motivational basis of insurance fraud is mainly associated with the desire to illegally obtain material benefits, reduce one’s own financial expenses or evade contractual obligations. At the same time, the nature of the motives may vary depending on the status of the offender, the characteristics of the insurance product, the economic situation and the level of control by the insurance company. One of the main features of insurance fraud is the illegal encroachment on the property interests of the insurer or other participants in insurance legal relations. An obligatory characteristic of insurance fraud is its illegal nature, which is manifested in the intentional misleading of the insurer by providing false information, concealing material circumstances or falsifying documents. Conclusion. It has been established that in the context of digitalization, the role of modern technologies in detecting and preventing insurance fraud is increasing. The use of Big Data tools, artificial intelligence and behavioral analytics for the timely identification of suspicious transactions is of particular importance. It is substantiated that effective counteraction to insurance fraud requires a comprehensive approach that combines the improvement of the internal control system, the development of human resources and the active interaction of insurers with state and law enforcement agencies.
Keywords : insurance fraud, signs of abuse in the insurance sector, mechanism for combating insurance fraud
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