What does opportunistic fraud typically involve?

Opportunistic fraud typically involves exaggerating or inflating a genuine claim. This type of fraud occurs when an individual takes advantage of a legitimate situation to gain a larger payout than what they are entitled to. For example, if a policyholder experiences a covered loss, they may inflate the value of the loss to receive a higher claim settlement. This is considered opportunistic because it exploits a genuine incident for personal financial gain rather than creating an entirely false scenario.

In contrast, creating new insurance policies does not align with the characteristics of opportunistic fraud, as this more closely resembles underwriting fraud, where individuals or entities create false policies for illicit benefits. Utilizing outdated underwriting practices does not pertain to the fraudulent actions of individuals seeking to manipulate claims but rather concerns the methods insurers might use for assessing risk. Finally, appealing claim denials could involve legitimate reasons based on the merits of the case, and while some might use it fraudulently, it doesn't specifically characterize opportunistic fraud as it doesn't involve inflating claims.