Page 26 - Insurance Times July 2021

2) Signature forgery on PIWC Dispute Settlement Form,
proposal form, Business Illustration etc.
3) Not disclosing the medical condition of the customer in
the proposal form.
4) Tampering the date of birth proof, age proof, Income
proof of the customer.
5) Clearing the PIWC call on behalf of customer.

At Policy Servicing Stage:
1) Documents tampered for change in nomination, change
in address, fund switch etc.
2) Providing intermediaries bank details for updation.
3) Forging signatures or using facsimile signatures on the
Y To monitor implementation of Anti-fraud policy for
documents provided by customer. (Eg- Signature
forgery on DGH, Assignment form etc.) effective deterrence, prevention, detection and
mitigation of frauds.
4) Renewal premium cheque cashiered as New Business
for target achievement.
2. Guidelines on Corporate Governance for
Central Public Sector Enterprises (CPSE's) issued
At Claims / Surrender Stage:
by Department of Public Enterprises (DPE)
1) Claiming the fraudulent death claim by intermediary or
by policy holders. The guidelines on Corporate Governance for listed and
unlisted Central Public Sector Entities (CPSEs) provide
2) Fictitious medical documents submitted in collusion with
guidelines on following aspects:
medical practitioners.
o Board of Directors
3) Tampering of the death claim documents (Fake death o Audit Committee
Certificate/7/12 certificate/Doctors Certificate) at the
time of claim. o Remuneration Committee
4) Bank account details tampered at the time of payout. o Subsidiary Companies

5) Signature forgery on KYC documents of customer, o Disclosures
Surrender form and Partial Withdrawal forms. o Report, Compliance and Schedule of Implementation

Fraud Regulations in India The Board should implement policies and

1. IRDAI Corporate Governance Guidelines 2016 procedures which should include:
(a) staff responsibilities in relation to fraud prevention and
Role and Responsibilities of the Board of identification
Directors:
(b) responsibility of fraud investigation once a fraud has
As an integral part of proper implementation of the business been identified
strategy, the Board should take action as under:
Y Establish appropriate systems to regulate the risk appetite (c) process of reporting on fraud related matters to
management
and risk profile of the Company. It will also enable
identification and measurement of significant risks to which (d) reporting and recording processes to be followed to
the company is exposed in order to develop an effective record allegations of fraud
risk management system.
(e) requirements of training to be conducted on fraud
Y Establish effective Risk Management framework and prevention and identification
recommend to the Board the Risk Management policy
and processes for the organization. Role of Audit Committee with respect to Fraud

Y Formulation of a Fraud monitoring policy and Management-
framework for approval by the Board. Reviewing the findings of any internal investigations by the

26 The Insurance Times, July 2021