Abstract We introduce a game-theoretic model to investigate the strategic interaction between a cyber insurance policyholder whose premium depends on her self-reported security level and an insurer with the power to audit the security level upon receiving an indemnity claim. Audits can reveal fraudulent (or simply careless) policyholders not following reported security procedures, in which case the insurer can refuse to indemnify the policyholder. However, the insurer has to bear an audit cost even when the policyholders have followed the prescribed security procedures. As audits can be expensive, a key problem insurers face is to devise an auditing strategy to deter policyholders from misrepresenting their security levels to gain a premium discount. This decision-making problem was motivated by conducting interviews with underwriters and reviewing regulatory filings in the US; we discovered that premiums are determined by security posture, yet this is often self-reported and insurers are concerned by whether security procedures are practised as reported by the policyholders. To address this problem, we model this interaction as a Bayesian game of incomplete information and devise optimal auditing strategies for the insurers considering the possibility that the policyholder may misrepresent her security level. To the best of our knowledge, this work is the first theoretical consideration of post-incident claims management in cyber security. Our model captures the trade-off between the incentive to exaggerate security posture during the application process and the possibility of punishment for non-compliance with reported security policies. Simulations demonstrate that common sense techniques are not as efficient at providing effective cyber insurance audit decisions as the ones computed using game theory.
The literature on economic theory of insurance fraud has developed two main approaches: and @cite_2 . The costly state falsification approach assesses the client's behaviour towards a claim. We consider the costly state verification approach, which focuses on the insurer identifying fraudulent claims. The insurer can verify the claims via auditing but has to bear a verification cost. The optimal claim handling usually involves random auditing @cite_30 .
@cite_30 @cite_2
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We survey recent developments in the economic analysis of insurance fraud. The paper first sets out the two main approaches to insurance fraud that have been developped in the literature, namely the costly state verification and the costly state falsification. Under costly state verification, the insurer can verify claims at some cost. Claims' verification may be deterministic or random, and it can be conditioned on fraud signals perceived by insurers. Under costly state falsification, the policyholder expends resources for the building-up of his or her claim not to be detected. We also consider the effects of adverse selection, in a context where insurers cannot distinguish honest policyholders from potential defrauders, as well as the consequences of credibility constraints on anti-fraud policies. Finally, we focus attention on the risk of collusion between policyholders and insurance agents or service providers. Abstract This paper characterizes the equilibrium of an insurance market where opportunist policyholders may file fraudulent claims. We assume that insurance policies are traded in a competitive market where insurers cannot distinguish honest policyholders from opportunists. The insurer-policyholder relationship is modelled as an incomplete information game, in which the insurer decides to audit or not. The market equilibrium depends on whether insurers can credibly commit or not to their audit strategies. We show that a no commitment equilibrium results in a welfare loss for honest individuals, which may even be so large that the insurance market completely shuts down. We also show that transferring monitoring costs to a budget-balanced common agency would mitigate the commitment problem. An insurer has to know the risks faced by a potential client to accurately determine an insurance premium offer. However, while the potential client might have a good understanding of its own security practices, it may also have an incentive not to disclose them honestly since the resulting information asymmetry could work in its favor. This information asymmetry engenders adverse selection, which can result in unfair premiums and reduced adoption of cyber-insurance. To overcome information asymmetry, insurers often require potential clients to self-report their risks. Still, clients do not have any incentive to perform thorough self-audits or to provide comprehensive reports. As a result, insurers have to complement self-reporting with external security audits to verify the clients’ reports. Since these audits can be very expensive, a key problem faced by insurers is to devise an auditing strategy that deters clients from dishonest reporting using a minimal number of audits. To solve this problem, we model the interactions between a potential client and an insurer as a two-player signaling game. One player represents the client, who knows its actual security-investment level, but may report any level to the insurer. The other player represents the insurer, who knows only the random distribution from which the security level was drawn, but may discover the actual level using an expensive audit. We study the players’ equilibrium strategies and provide numerical illustrations. We consider a model for price calculations based on three components: a fair premium; price loadings reflecting general expenses and solvency requirements; and profit. The first two components are typically evaluated on a yearly basis, while the third is viewed from a longer perspective. When considering the value of customers over a period of several years, and examining policy renewals and cross-selling in relation to price adjustments, many insurers may prefer to reduce their short-term benefits so as to focus on their most profitable customers and the long-term value. We show how models of personalized treatment learning can be used to select the policy holders that should be targeted in a company’s marketing strategies. An empirical application of the causal conditional inference tree method illustrates how best to implement a personalized cross-sell marketing campaign in this framework.