General insurers crack the whip on claim fraudsters

In Hyderabad, a customer of Bajaj Allianz General Insurance, was hospitalised with viral pyrexia and enteric fever. After being admitted for a week, he was discharged, post which he approached them for claim reimbursement. Upon scrutiny, it was realised that the claim amount for the mentioned ailment was higher than the usual amount. This triggered suspicion within the company. Later, it was found that the claim was baseless.

The Investigation and Loss Mitigation team of Bajaj Allianz visited the concerned hospital to verify the medical records of the claimant. After repeated follow ups by the in-house team and ambiguous responses given by the hospital authorities, the team was unable to procure any documents to support the treatment. Eventually, the hospital authorities clearly denied providing any documents, stating that due to shift in the hospital management, retrieving the bills was not possible Free Stock Share Tips

Finally, a search on social media websites turned out to be fruitful as the official had updated images of a ceremony on the same day he claimed to be admitted in the ICU for treatment. He was not only away from the hospital, attending a formal ceremony, but also looked physically sound and healthy; so the claim was totally false. 

Sanjiv Kumar Dwivedi, VP, fraud prevention and loss mitigation, Bajaj Allianz General Insurance believes that risk management in insurance is crucial as insurance companies lose approximately 6% of their revenue annually due to fraud and abuse (exaggeration of claims) Personal Numerology Trading Tips

General insurance companies have been facing several suspicious claims. This not only includes fake hospital bills, exaggerated claims but even fraudulent pathology lab reports Commodity Trading Tips

Non-life insurers are cracking the whip on these fraudsters by giving out red flags for certain instances and also tracking social media activities of suspicious claimants. 

KK Mishra, MD and CEO, Tata AIG General Insurance said that with multiple hospitals all across the country charging different rates, there are people who are out to make a quick buck through insurance purchase.

"At this point, the problem also is that there is no law under CrPC which classifies insurance fraud as a criminal offence. Steps are being taken to build up a data bank of hospitals by the industry/Insurance Information Bureau of India to identify all hospitals across the country," he explained Nifty Trading Tips

Tata AIG has taken stringent steps including placing red flags on certain instances. They have 18 such red flags in auto insurance and 15 red flags in health insurance. Mishra said that they also look into the operation costs in a standard hospital. If an individual presents a much higher bill from an unknown place contrary to what is usually charged, they investigate the case.

Non-life insurers also look at those regions carefully where there have been past instances of fraud. Sanjay Datta, head of underwriting and claims at ICICI Lombard General Insurance said that the fraud numbers are high in motor and health insurance. 

"We are trying to identify areas where such fraud claims originate from, so that they regions can be avoided. There are several pockets from where such instances take place, including exaggerating repair bills for their cars among others," he said Astrology & Numerology books

A study of Accenture also found that 24% think exaggeration of claims is perfectly normal. 11% of people with insurance feel that fabrication is also fine. But more alarming was the fact that almost 92% of the people surveyed claimed they have come across fraud in some form or the other. 

Motor and health insurance are the two prominent segments that have seen a maximum spurt in the number of fraud cases. In case of motor insurance, users create fake policy as the law enforcement agency does not have any mechanism to verify if the document is real or fake. Dwivedi said that there are touts which fraudulently create letter-heads of insurance companies and sell these as motor insurance documents. 

Tampering with the date of loss has also become common. 

Rajagopal G, Head of Operations and Claims, Bharti AXA General Insurance explained that in the health insurance segment, the common malpractice by policy holders are concealment of pre-existing diseases, failure to report relevant information/ providing false information regarding state of health or purpose of hospitalisation Astrology market books

He said that the also encounter cases where the insured tries to get routine diagnostic investigation bills passed as treatment for some ailment. The company also has a data analytics team in place to spot and negate fraudulent claims early. 

Others are looking to take the help of technology for motor insurance. Bajaj Allianz plans to introduce QR codes for motor insurance. Further, the company also makes use of ample technology like simulators to reconstruct accidents and figure out the reality of claims. 

Claims investigation teams are also getting sophisticated with insurers like Bajaj Allianz hiring forensic specialists and investigators, medical officers in their team.

Steve Hollow, deputy CEO of SBI General Insurance said that the approach of the claims fraud and investigation team is to create and integrate claims fraud & investigation framework across all claim portfolios like motor own damage, motor third party, motor theft, personal accident, health, commercial line, property claims, by identifying industry standard fraud triggers, standard investigation process, governance, control Financial Astrology Trading Tips

Hollow said that some of the triggers for investigations could include late night accidents, claims immediately after buying a new policy, loss not matching vehicle damage amongst others.

For instance, they had a truck accident where the right side of the truck was damaged in a highway collision. However, as per the claimant, the cleaner was dead due to impact and not the driver. Further investigation and medico legal scrutiny proved conclusively that the cleaner and not the driver was driving the truck at the time of the accident. The malafide intention was to suppress the fact that the actual driver was not having an effective driving license on the material time of the loss.

While insurers had decided to have a common data exchange platform through credit information company Cibil, industry sources said that it has not taken off. This is because insurers are reluctant to share customer data, for fear of them being poached by a rival insurer Jackpot Trading Tips