Investigation of insurance frauds from a perspective of insurance companies in Slovenia and Austria

Diplomsko delo je sestavljeno iz teoretičnega dela, ki predstavlja večino naloge ter empiričnega dela, ki temelji na zbranih statističnih podatkih, pridobljenih s strani slovenskih in avstrijskih zavarovalnic. Namen diplomskega dela je bil preučiti potek oz. način preiskovanja zavarovalniških goljufij v zavarovalnicah ter koristi pri preiskovanju le-teh, s pomočjo sodobne tehnologije. Ugotavljali smo kolikšen je škodni delež in katere zavarovalnice imajo velike izgube zaradi zavarovalniških goljufij. Povzročena škoda je osrednja tema diplomskega dela. V prvem, to je teoretičnem, delu diplomskega dela je predstavljena zgodovina oz. razvoj zavarovalništva pri nas in v Avstriji. V nadaljevanju je opisana zavarovalniška goljufija, njene vrste, načini, oblike in storilci. Osredotočili smo se tudi na goljufije iz kazenskega vidika in na razreševanje goljufij v zavarovalnicah, kjer smo izpostavili metodo, narejeno pri Zavarovalnici Triglav, za pomoč pri preiskovanju zavarovalniških goljufij. V drugem delu diplomskega dela so predstavljeni zbrani (pridobljeni) podatki iz zavarovalnic v Sloveniji in Avstriji. Največ podatkov smo pridobili s strani Slovenskega in Avstrijskega zavarovalnega združenja, saj je javno dostopen vsem. Ugotavljali smo, v kateri državi se povprečno izvaja največ zavarovalniških goljufij in kolikšen škodni delež utrpijo posamezne zavarovalnice zaradi tega kaznivega dejanja. Pridobljene statistične podatke smo analizirali povprečno na 5 let (od leta 2006 do 2010) oz. od količine pridobljenih podatkov, pri čemer moramo povedati, da so bili v določenih zavarovalnicah precej skopi ter s podatki in so nam s tem otežili delo.The thesis is composed of mostly theoretical data but also empirical work, which is based on the collected statistical data, obtained from Slovenian and Austrian insurance companies. The aim of this thesis was to examine the course or way of investigating insurance frauds and benefits in investigating them, with the help of modern technology. The central thesis of this work was to examine proportion of the damage and determine which insurance companies have large losses due to insurance fraud. The first, theoretical, part of the thesis presents the history and developments of insurance industry in Slovenia and Austria. In addition there is a detailed insurance fraud description, for example its types, methods, forms and perpetrators of it. We also focused on fraud from the criminal point of view and resolution of fraud in insurance companies, where we exposed a method developed by Triglav Insurance Company for assistance in investigating insurance fraud in general. The second part of the thesis presents the collected data from insurance companies in Slovenia and Austria. Majority of data was collected from web pages of Slovenian and Austrian Insurance Association, which are publicly accessible. This information helped us determine which country average the most insurance frauds, in addition it was also important to determine what is the share of loss suffered by an individual insurance due to this offense. The acquired statistical data were analyzed for average of 5 years (2006-2011) or by the amount of collected data, which was from certain insurance companies rather sparse, this made our researching much more difficult