Q: How serious is the fraud in the Insurance sector?
Response:
Insurance companies have been impacted by fraudulent activities, suffering financial losses as a result. Most industry experts believe that fraud exists anywhere between 10-15% and they are being discovered across lines of business.
The Insurance Regulatory and Development Authority of India (IRDAI)sets out 3 broad categories of fraud - Policyholder Fraud and/or Claims Fraud, Intermediary Fraud and Internal Fraud.
It has been observed that in motor claims; motor OD/theft/ personal accident/ third party frauds occur on account of misrepresentation of facts, fabrication of documents and or implantation of driver or vehicle to get undue gain from Insurance Company.
In property claims we observe misrepresentation of quantity and quality of material lost or destroyed. Arson is represented as fire loss.
In health indemnity, we observe frauds on account of fake/ fabricated treatment records, fabrication of bills/ medical documents, misrepresentation of facts like increase in length of stay, outdoor patient treatment converted to indoor patient department, formation of fake Small & Medium Enterprises (SME) entities for the purpose of Insurance claims etc.
In Personal accident claims we observe frauds on account of forged and or fabricated Police records, medical records for cause of death including post-mortem reports, forged treatment records for disability and on account of misrepresentation of facts around the cause of death to get benefit of Insurance.
We also observe fraud on account of dishonesty of employees or intermediary in form of premium siphoning or fake/ forged reimbursement claims, claims fraud, issuance of fake policy by external entities.
Q: What step companies are taking to stop this?
This story is from the July 2023 edition of THE INSURANCE TIMES.
Start your 7-day Magzter GOLD free trial to access thousands of curated premium stories, and 8,500+ magazines and newspapers.
Already a subscriber ? Sign In
This story is from the July 2023 edition of THE INSURANCE TIMES.
Start your 7-day Magzter GOLD free trial to access thousands of curated premium stories, and 8,500+ magazines and newspapers.
Already a subscriber? Sign In
Interview: Johnson Varughese Chief Executive Officer WALAA Insurance Company Al-Khobar, Kingdom of Saudi Arabia
\"Establishment of the IA will accelerate the growth of the Insurance Sector as the Industry will now get focused attention. The strategy of IA is likely to be aligned with Vision 2030 and Financial Sector Development plan. Since savings is one of the pillars of Vision 2030, I hope to see a lot of emphasis on Protection and Savings Insurance Products.\"
IRDAI Corner
Investments in Infrastructure Debt Funds - NBFC
2023 was a watershed year for insurance sector, but there's more to come
Innovation in regulatory framework, promotion of ease of doing business while enhancing protection of policyholders’ interests and measures taken to expand the reach of insurance penetration make 2023 a year to remember in the insurance industry.
The Future of Insurance: ESG as a Cornerstone of Sustainable Underwriting
As climate change, social inequality, and governance issues become increasingly prominent, insurers are recognizing the need to integrate Environmental, Social, and Governance ESG) factors into their underwriting processes. This shift not only aligns with global efforts to address pressing issues but also positions the insurance industry as a key player in promoting sustainability and a fraternity who is concerned about their ESG goals.
Cancer Insurance - An Indispensible cover
Recent advances in cancer treatment have opened new treatment options, such as targeted therapy and immunotherapy, for people diagnosed with advanced-stage disease. However, these advanced treatments are costly and remain out of reach of many.
Emerging Horizons: New Opportunities in Commercial General Insurance Segment
The Indian economy continues to be a beacon of growth and opportunity, attracting both domestic and foreign investments across various sectors. The country's economic reforms and ease of doing business initiatives have further improved the investment climate, fostering entrepreneurial spirit and innovation.
Interview: Dr Tarun Agarwal Director National Insurance Academy, Pune
\"National Insurance Academy is undoubtedly the most renowned institution not just in India, but internationally. We are an apex institution in the field of education, training, research and consultancy in insurance, pension and allied areas.\"
Historical Maritime Fraud
M.V B-Atlantic - War Risk Cover: An Insurer’s Dilemma or Fraud!!
Navigating the natural conundrum: Why Reinsurers continue to maintain positive outlook for non life Insurance market in asia pacific region in 2024 & beyond despite challenges posed by natural hazards
The Asia-Pacific region has long been susceptible to a range of natural hazards, including earthquakes, typhoons, floods, and tsunamis. These events pose significant challenges to the insurance industry, particularly the non-life insurance sector, which covers property, casualty, and other general insurance lines.
Trust with Law
Khaitan Legal Associates' website succinctly proclaims, \"We are a value-driven law firm.