The use of analytical techniques for fraud detection and the design of fraud detection systems have been topics of several research projects in the past and have seen varying degrees of success in their practical implementation. In particular, several authors regard the use of credit risk scorecards for fraud detection as a useful analytical detection tool. However, research on analytical fraud detection for the South African insurance industry is limited. Furthermore, real world restrictions like the availability and quality of data elements, highly unbalanced datasets, interpretability challenges with complex analytical techniques and the evolving nature of insurance fraud contribute to the on-going challenge of detecting fraud successfully. Insurance organisations face financial instability from a global recession, tighter regulatory requirements and consolidation of the industry, which implore the need for a practical and effective fraud strategy. Given the volumes of structured and unstructured data available in data warehouses of insurance organisations, it would be sensible for an effective fraud strategy to take into account data-driven methods and incorporate analytical techniques into an overall fraud risk assessment system. Having said that, the complexity of the analytical techniques, coupled with the effort required to prepare the data to support it, should be carefully considered as some studies found that less complex algorithms produce equal or better results. Furthermore, an over reliance on analytical models can underestimate the underlying risk, as observed with credit risk at financial institutions during the financial crisis. An attractive property of the structure of the probabilistic weights-of-evidence (WOE) formulation for risk scorecard construction is its ability to handle data issues like missing values, outliers and rare cases. It is also transparent and flexible in allowing the re-adjustment of the bins based on expert knowledge or other business considerations. The approach proposed in the study is to construct fraud risk scorecards at entity level that incorporate sets of intrinsic and relational risk factors to support a robust fraud risk assessment. The study investigates the application of an integrated Suspicious Activity Assessment System (SAAS) empirically using real-world South African insurance data. The first case study uses a data sample of short-term insurance claims data and the second a data sample of life insurance claims data. Both case studies show promising results. The contributions of the study are summarised as follows: The study identified several challenges with the use of an analytical approach to fraud detection within the context of the South African insurance industry. The study proposes the development of fraud risk scorecards based on WOE measures for diagnostic fraud detection, within the context of the South African insurance industry, and the consideration of alternative algorithms to determine split points. To improve the discriminatory performance of the fraud risk scorecards, the study evaluated the use of analytical techniques, such as text mining, to identify risk factors. In order to identify risk factors from large sets of data, the study suggests the careful consideration of both the types of information as well as the types of statistical techniques in a fraud detection system. The types of information refer to the categories of input data available for analysis, translated into risk factors, and the types of statistical techniques refer to the constraints and assumptions of the underlying statistical techniques. In addition, the study advocates the use of an entity-focused approach to fraud detection, given that fraudulent activity typically occurs at an entity or group of entities level. / PhD, Operational Research, North-West University, Vaal Triangle Campus, 2011

The purpose of this research was to evaluate performance claims in athleisure, in order to confirm or refute their authenticity. Aesthetic properties and functional claims were evaluated initially, and after repeated home laundering. A convenience (nonprobability) sample of activewear with performance features consisted of ninety garments that are currently on the market and commonly used by consumers. The garments included men’s and women’s t-shirts, polos, leggings, windbreakers, hoodies, sweatpants, and warm-up pants of various fiber contents and performance chemistries. The focus of the garment selection was on garments with performance properties relating to moisture management. Performance claims listed on the hang tags included moisture management, wicking, quick dry, stay cool, breathable, water resistant and wind resistant. Garments in the sample were a combination of natural, synthetic and blended fiber contents. The garments were tested initially, after one, five, ten, fifteen and twenty laundry cycles. The garments were evaluated for smoothness, dimensional stability, color change, pilling, horizontal wicking of textiles, water repellency- spray test, water resistance- impact penetration, water resistance- hydrostatic pressure, absorbency of textiles, aqueous liquid repellency and air permeability. All testing was performed in accordance with AATCC and ASTM standard test methods and was conducted under controlled laboratory settings.

This study is devoted to a detailed survey of the claims administrative machinery of the State of Texas workman's compensation program.

Changes and claims under FIDIC commercial terms in the context of the Civil Code and public procurement law FIDIC commercial terms are one of the most popular commercial terms in construction all over the world. Its regulation of Variations and Claims during the constructions works is certainly very important for successful progress of the construction. However, in the context of the Czech Civil Code and public procurement rules, there can raise issues of applicability of such regulation under FIDIC in Czech law environment and also compliance with public procurement regulation. The aim of this thesis is an analysis of applicability of Variations and Claims under the FIDIC regarding to the Czech Civil Code and public procurement rules. After an introductory part, the thesis is divided into four main chapters. The first chapter describes the FIDIC Federation and history of its commercial terms. The second chapter outlines basic description of Variations and Adjustments and Claims and connected questions including the procedure issues. Following two chapters are the main parts of the thesis. The third chapter is focused on Variations and Adjustments and Claims under the FIDIC commercial terms regarding the Czech law environment and recently adopted Civil Code. The last chapter is focused on public...

This work aims to provide a comprehensive overview of the raising the claim in the insolvency proceedings. There is an explanation provided for each type of claims together with practical examples targeting the most problematic aspects of application of Act No. 182/2006 Coll., on bankruptcy and means of resolution thereof (hereinafter "The Insolvency Act").The work is not limited only to a process of raising the claim in insolvency proceedings but it systematical describes further existence of raised claim in the insolvency proceedings. There are also two more chapters dealing with the review of claims and their satisfaction. The work deals with the effective legislation, meaning the insolvency act. There is pointed toward the specific legislation in specific cases when adequate. This legislation is contained in the Act No. 328/1991 Coll., on bankruptcy and settlement (hereinafter "The Bankruptcy and Settlement Act"). I also took into account the significance of the novelization of the insolvency act number 294/2013 Sb. (so called revision novelization) and I point out the cases of modifications based on this novelization.. I also refer to the previous legislation contained in the bankruptcy act. Together with this I explain the development of insolvency law from the adoption of an insolvency act until now....

v anglickém jazyce The subject of presented Master's degree thesis is Raising claims in insolvency proceedings. The purpose of this thesis is to analyze this issue from the view of present legislation and judicial decisions and to point out some interpretation problems. Recent amendments of legal regulation as well as proposed bills were taken into account too. This thesis is divided into nine chapters. Chapter One introduces an initial part of insolvency proceedings, which starts with the commencement of insolvency proceedings and ends with the decision on the bankruptcy. It is concerned with an insolvency petition and analyzes its requirements and effects. This is followed by description of a court procedure regarding the alternatives of decisions on the insolvency petition. The consequences of unfounded insolvency petition and subsequent liability of petitioner were not left without attention as well. Chapter Two is focused on the creditor as a participant in the insolvency proceedings. Creditors are divided into five groups by the character of their claims. In these groups is a position of creditors in the proceedings defined especially with regards to the way of raising their claims. Next two chapters represent the key part of this thesis. As its title suggests, it relates to raising claims in...

Title: Parameterization of claims distribution in non-life insurance Author: Bc. Mária Špaková Department: Department of Probability and Mathematical Statistics Supervisor: RNDr. Michal Pešta Ph.D., MFF UK Abstract: This paper deals with the parameterization of claim size distributions in non-life insurance. It consists of the theoretical and the practical part. In the first part we discuss the usual distributions of claims and their properties. One section is devoted to extreme values distributions. Consequently, we mention the most known methods for parameter estimation - the maximum likelihood method, the method of moments and the method of weighted moments. The last theoretical chapter is focused on some validation techniques and goodness-of-fit tests. In the practical part we apply some of the discussed approaches on real data. However, we concentrate mainly on the large claims modeling - firstly, we select a reasonable threshold for our data and then we fit the claims by the generalized Pareto distribution together with the introduced parameterization procedures. Based on the results of the applied validation methods we will choose appropriate models for the biggest claims. Keywords: parameterization, non-life insurance, claims distribution.

This paper examines determinants of creditors' claims satisfaction in insolvency proceedings in the Czech Republic. To our knowledge, it is the first research to such extent in the Czech Republic covering this field. Combining microdata from Insolvency Register, Business Register, Ministry of Finance and other sources, we construct a unique dataset of more than 2,600 cases. We identify several basic determinants of satisfaction: a higher share of secured claims, real estate and cash in assets of a company, submission of financial statements into Business Register, selling the business as a whole within the proceedings, and entrepreneur cases. We find no such effect for the audit of financial statements or for the age of a company. Moreover, we search for other indicators that may result in the lower satisfaction of claims, out of which five are statistically significant: a homeless person in statutory body, registered office at a firm nest, being listed as unreliable VAT payer, a connection to persons that have multiple records in Insolvency Register and a substantial increase in depreciation in the period between the last two submitted financial statements. In contradiction to the bankruptcy prediction literature, we show that the financial data are unreliable for predicting the outcome of insolvency...

Master of Science / Department of Statistics / Haiyan Wang / Estimating unpaid liabilities for insurance companies is an extremely important aspect of insurance operations. Consistent underestimation can result in companies requiring more reserves which can lead to lower profits, downgraded credit ratings, and in the worst case scenarios, insurance company insolvency. Consistent overestimation can lead to inefficient capital allocation and a higher overall cost of capital. Due to the importance of these estimates and the variability of these unpaid liabilities, a multitude of methods have been developed to estimate these amounts. This paper compares several actuarial and statistical methods to determine which are relatively better at producing accurate estimates of unpaid liabilities. To begin, the Chain Ladder Method is introduced for those unfamiliar with it. Then a presentation of several Generalized Linear Model (GLM) methods, various Generalized Additive Model (GAM) methods, the Bornhuetter-Ferguson Method, and a Bayesian method that link the Chain Ladder and Bornhuetter-Ferguson methods together are introduced, with all of these methods being in some way connected to the Chain Ladder Method. Historical data from multiple lines of business compiled by the National Association of Insurance Commissioners is used to compare the methods across different loss functions to gain insight as to which methods produce estimates with the minimum loss and to gain a better understanding of the relative strengths and weaknesses of the methods. Key

The theme of the work is credit risk insurance. The main objective is to analyze this specific type of insurance, define its role in insurance system and for covering credit risk. Analyzed are both commercial insurance and insurance with state support. The important part of this work is also analysis of czech and world insurance markets and influence of global economic recession. At the end of the work there are presented alternative instruments for minimizing credit risk and their comparison with insurance products.