Page 10 - Risk Management Bulletin Jan- Mar 2021

RMAI BULLETIN JANUARY TO MARCH 2021

4) Providing fake KYC/confidential report of sales 5) Signature forgery on KYC documents of customer,
representative/ moral hazard. Surrender form and Partial Withdrawal forms.
5) Changing customer DOB/ Age proof etc. so that
the customer can fit in a particular product. Fraud Regulations in India
6) Report with wrong declaration or improper 1. IRDAI Corporate Governance Guidelines
verification/Issuing fake receipt/fake policy. 2016
7) Falsifying and/or damaging/destroying Role and Responsibilities of the Board of
documentation/OSV done for forged documents.
Directors:
8) Sourcing business to a nonexistent customer. As an integral part of proper implementation of the
9) Sourcing business without customer's knowledge. business strategy, the Board should take action as
under:
10) Providing customer incorrect Mobile No./ Mail id
Y Establish appropriate systems to regulate the risk
for clearance of PIWC call.
appetite and risk profile of the Company. It will also
enable identification and measurement of significant
At New Business stage:
risks to which the company is exposed in order to
1) Intermediary in coordination issuing fake medical develop an effective risk management system.
documents of customer.
Y Establish effective Risk Management framework and
2) Signature forgery on PIWC Dispute Settlement recommend to the Board the Risk Management
Form, proposal form, Business Illustration etc.
policy and processes for the organization.
3) Not disclosing the medical condition of the
Y Formulation of a Fraud monitoring policy and
customer in the proposal form.
framework for approval by the Board.
4) Tampering the date of birth proof, age proof,
Y To monitor implementation of Anti-fraud policy for
Income proof of the customer.
effective deterrence, prevention, detection and
5) Clearing the PIWC call on behalf of customer. mitigation of frauds.
At Policy Servicing Stage: 2. Guidelines on Corporate Governance for
1) Documents tampered for change in nomination, Central Public Sector Enterprises (CPSE's)
change in address, fund switch etc.
issued by Department of Public Enterprises
2) Providing intermediaries bank details for updation. (DPE)
3) Forging signatures or using facsimile signatures on The guidelines on Corporate Governance for listed and
the documents provided by customer. (Eg- unlisted Central Public Sector Entities (CPSEs) provide
Signature forgery on DGH, Assignment form etc.) guidelines on following aspects:
o Board of Directors
4) Renewal premium cheque cashiered as New
Business for target achievement. o Audit Committee

o Remuneration Committee
At Claims / Surrender Stage:
o Subsidiary Companies
1) Claiming the fraudulent death claim by
intermediary or by policy holders. o Disclosures
2) Fictitious medical documents submitted in o Report, Compliance and Schedule of
collusion with medical practitioners. Implementation
3) Tampering of the death claim documents (Fake The Board should implement policies and
death Certificate/7/12 certificate/Doctors
procedures which should include:
Certificate) at the time of claim.
(a) staff responsibilities in relation to fraud prevention
4) Bank account details tampered at the time of and identification
payout.

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