Page 20 - Life Insurance Today January-June 2020

premium rate for all Term Insurance covers from April, Customers may also be found involved in
2020. Simultaneously in this backdrop of conglomeration
health-claim fraud in some ways like -
and hipped up of likely claims to be registrar, steps for fraud 1. Filing claims for such medical services which are not
detection and dealing with fraud cases under the health
actually received by him/her.
are posed a tremendous challenge. Main impact will be on
the health insurance related claims under the Life Insurance 2. Falsification of records for illegally obtaining insurance
coverages. benefits.

This prolonged lockdown period has also changed the While summing up:
insurance operation where the agents have learnt to From whatever has been discussed, it may be concluded
distinctly communicate and sale the insurance products on that the life insurance business is growing at current annual
mobile net via video calling and basically being imbibed to rate of 21.9%. However the insurance penetration in the
the habit of operating, transacting and sharing data country is very poor. The insurance market has witnessed
digitally all on a sudden maintaining the norms of working a dynamic change which includes presence of a fair number
from home and social distancing. of life segments. Most of the private insurance companies
have formed joint venture with recognized foreign players
But the aspect of evidence of moral hazard in insurance across the globe. To achieve success in the marketing of
parlance has not been addressed adequately. "Fraud the Life insurance products, the entire business
management" is grey area and TPAs or insurers have not environment is required to be considered.
been very successful in detecting and preventing the
healthcare frauds. The lack of objective measures in The strategies are to be adopted based on the dynamics
treatment protocols and standard treatment guidelines are of the market trends. To be successful, a life insurer must
the causes of the healthcare provider related frauds being have quality people, innovative management, be able to
inflicted on the insurer community. Three parties may be employ technology effectively, besides having the right
associated with these Health insurance frauds: (a) Service products and distribution channels. At a personal level,
providers which include doctors, hospitals, ambulance buying life insurance as a priority will provide more people
companies and laboratories, (b) Insurance companies and ultimately to reduce their financial anxiety and also
intermediaries like TPAs, and (c) Customers. ensuring their medical security simultaneously.

Service providers' fraud include for:- References:

1. Billing for services which are not actually performed. Different contemporary discussions & information as
collected & collated from various text materials available
2. Carrying on unnecessary diagnostic and other tests by
on-line & in hard copies.
way of falsification of medical history of the patient.
3. Providing unnecessary services to attract more money Web Resources:
from the insurers.
1. www.irdaindia.org
4. Billing more costly services than the one actually
2. www.insuranceinstituteofindia.com
performed.
3. https://economictimes.indiatimes.com/industry/
banking/finance/insure/insurance-sector-in-need-of-
Commitment of fraud by insurance companies positive-enablers-say-industry
or intermediaries may be due to - 4. https://economictimes.indiatimes.com/hdfc-life-
1. Involvement of employees in creating false claims. insurance-company-ltd/stocks/companyid-3068.cms
2. Illegal gratification from the healthcare service 5. www.businessinsurance.com
providers. 6. https://www.paisabazaar.com/insurance -companies

Happiness is the absence of the striving for happiness.

20 January - June 2020 Life Insurance Today