Question

Give opinion:

I work for an insurance company and one of the biggest ethical dilemmas we face on a regular basis is insurance fraud. Many people do not fully understand or ate educated on Insurance and the policies that they hold. With that, often times the general public will have a negative opinion towards insurance companies, A customer will feel as thought the insurance company did not pay in full what is owed to them. This leads to some customers to commit insurance fraud, but do not feel they are acting unethically because they are holding more of an individualism viewpoint because they are looking out for their own interest and are only potentially hurting a big company that is capable of paying out "what is owed".

The growth of this type of problem has led insurance companies to develop teams to investigate potential fraudulent claims. Sometimes the fraudulent behavior manifests in getting a healthcare provider to upcharge a service or increase the level of treatment that is necessary. Others may omit pertinent information about an actual claim. Some consumers will create a false claim in hopes of getting paid out for it. Insurance fraud has become "a particularly costly form of unethical consumer behavior, [and] is the focus of many recent articles in business ethics" (Warren, 2018).

For my company, those who work as a part of the investigative unit tend to be either ex-military or ex-police force due to their experience and training. During investigation they have to rely on their knowledge and skill to make decisions about certain situations. Ethics plays such a major role during these investigations to ensure rights and morals are protected for both the consumer and the insurer.

Answer 1

Most of the mature management has started realizing that only socially responsible behavior can work towards building favorable public opinion. It is not that they are altruistic - not because they are interested in public relations. The managers have to face a dilemma of where to draw a line. It is to be noted that while Business ethics on the part of the Organizations is always highlighted in any given industry, little do the unethical practices of consumers brought into the light. If the Organizations fail to perform their part of the duty well, the Public is possibly there to question such an Organization but it is, on the other side, very difficult to raise fingers upon the individuals in Public when they do not act ethically and commit crimes like that of the presentation of the fraudulent claims to get reimbursed for supposedly what they “owe” to the Insurance Houses. I think, it is high time that the society realizes that ethics are not just those set of moral practices that are to be undertaken only by the Corporate Houses to help serve the consumers better but instead, ethics are universal in nature and all-pervasive. Insurance policy holders are also supposed to act in a fiduciary manner, disclose the relevant facts relating to the policy to the Insurance Companies and genuinely cooperate with the Insurance Companies to get reimbursed with what actually such policy holders suffered with, within the framework of the Policy contract. Only in this manner, one can assure that the ethical culture is established int he society in true sense.