Contabilidade forense e compliance como instrumentos necessários ao combate às fraudes em seguros

Abstract

The cases of fraud and corruption have increased and become more sophisticated. Non-life insurance companies invest in technology and use forensic accounting and compliance mechanisms to investigate and prepare administrative and judicial proceedings. Accordingly, this research aims to compare the proportion of incurred, suspected, and investigated claims in elementary insurance, between two periods (2018-2019, and 2020-2021). And, more specifically, to identify in integrated and/or sustainability reports the main techniques or guidelines of Forensic Accounting. The techniques used in this study were documentary research, with a quantitative, descriptive, and qualitative approach using content analysis. The sample represents 91% of the insurance companies operating in the country. The main results showed that of the total number of claims in the first period, approximately 14.02% refer to suspected fraud; 20.98% on average refer to investigated and proven fraud; in the second period the fraud proven was 17.01%. There were no statistically significant differences in the indicators between the two periods. Mechanisms to combat fraud and corruption, risk management, and compliance management were observed in the sustainability reports. Practical contributions highlight that the absence of a significant difference suggests that the increase in asymmetric information, due to the absolute growth of cases, was also not relevant. This evidenced, to the stakeholders, an increase in the suspicion of claims occurring with Transportation, with proven frauds at 93.98%.