| dc.description.abstract | The vast majority of insurance plans include common statement indicating that in the event
of a fraudulent claim, all policy benefits are null and void. The fraudulent insurance claims
have the ability to destabilize the economy, bankrupt financial and banking institutions,
damage government operations, disrupt tax-funded development efforts, and erode public
trust in government administration. The purpose of this research was to determine the effect
of forensic accounting techniques on the efficiency of claim settlement in Kenya's health
insurance sector. Among the specific goals was to investigate the effect of fraud detection
technologies, litigation support strategies, and dispute resolution practices on claim
settlement efficiency in Kenya's health insurance sector. The study is significant to
insurance companies, Insurance Regulatory Authority of Kenya and future, academics and
researchers. The study was anchored on Occupational Fraud Theory, Moral Hazard Theory
and White-Collar Crime Theory. The study adopted descriptive research design. The
population of interest constituted administrative staff from head offices of medical
insurance companies. The study adopted census design whereby all the 32 medical
insurance providers were involved in the study. The questionnaire was the main primary
data collection method. The data was quantitatively analyzed aided by SPSS package to
generate percentage ratings, frequencies inferential statistics. Presentation was done in
form of tables. The study found that in fraud investigation, it could be easier to monitor
and keep trail of any fraud if it arises considering that systems of claims settlement are in
place. In litigation support, clients might receive assistance from insurance companies to
reduce the cost effect of the risk of legal action while others claim that insurance companies
may not necessarily engage in helping clients on various legal engagements. Lastly, in
dispute resolution, settling a dispute about claims can be done through court of laws, thus,
providing documented evidence for claim processing. However, this may amount to
notable inefficiency as court proceedings may last longer than the claimants anticipate. The
study recommends that policy makers in the insurance companies should ensure that fraud
investigations are properly documents and be carried out in the shortest time possible to
fulfill expected efficiency in claim settlement. Still, the companies should be obligated
enough to invest own funds to take care of legal claims in relations to litigations. The
management of the insurance firms should ensure that they put in place dispute resolution
mechanism that is workable and that can support quick settlement of complaints on claims. | en_US |
