Stakeholder Perceptions of Anti-Fraud Mechanisms and Their Implications in the Nepalese Insurance Sector
Stakeholder Perceptions of Anti-Fraud Mechanisms and Their Implications in the Nepalese Insurance Sector

Summary/Abstract: Despite increasing instances of fraudulent activities within the Nepalese insurance sector being periodically revealed by government bodies, regulatory authorities, and investigative journalists, a systematic academic inquiry into this issue has remained notably absent. To address this gap, an exploratory cross-sectional quantitative investigation was conducted to examine stakeholder perceptions regarding the effectiveness of fraud control mechanisms and the primary repercussions of insurance fraud on insurers in Nepal. Data were collected through a structured questionnaire administered to 200 respondents including insurance employees, policyholders, agents, insurance technicians, surveyors, and domain experts within the Pokhara Valley, selected via convenience sampling. Analytical procedures included descriptive statistics, Mann–Whitney U tests, and Kruskal–Wallis H tests. It was identified that robust legal enforcement, particularly the enactment and strict implementation of antifraud legislation, was perceived as the most effective control strategy. Institutional reforms, such as the establishment of a dedicated Fraud Investigation Bureau and a centralized Insurance Information Centre, were also emphasized as critical to improving the detection and monitoring of fraudulent activities. Although technologyenabled solutions, including AI-driven digital claim management and anomaly detection systems, were acknowledged for their importance, they were ranked marginally lower in perceived efficacy compared to legal and institutional measures. Fraud was reported to exert significant detrimental effects on insurers, most prominently through the erosion of public trust and social credibility. Additional impacts included claim settlement delays, reduced profitability, destabilization of share prices, and increased insurance premiums, collectively threatening both the short-term financial performance and long-term sustainability of the sector. To safeguard stakeholder interests and ensure sectoral stability, a multi-pronged anti-fraud framework has been recommended. Main recommendations include strengthening the legal framework with stringent penalties, developing a centralised fraud registry for inter-insurer information sharing, enhancing underwriting and claims verification procedures, and investing in intelligent fraud detection technologies. These findings offer empirical insights that can guide policy reform and institutional development in emerging insurance markets.

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