Page 38 - Insurance Times Octoberr 2022

to their respective Boards for review and course correction. comprehensive. Perpetrators have the creativity to identify
Insurers are liable to inform both potential and existing ways of subverting the system, so staying ahead needs
clients about their anti-fraud policies. Insurers include constant software upgradation and monitoring by seasoned
necessary cautions in the insurance contracts and relevant professionals!
documents, duly highlighting the consequences of submitting
a false statement and/or incomplete statement, for the Combating the digital fraudster:
benefit of the policyholder, claimants and their beneficiaries.
The problem with insurance companies in India is that they
do not extensively share data as banks do. This is the reason
Control by means of identifying triggers why every insurance company has to rely on its own network
Fraudsters have become increasingly innovative. Newer to detect fraud. It is extremely important that all insurance
ways of cheating the insurance companies are being used companies form a common database and start sharing
almost every day. One of the ways to control fraud is to fraud data extensively. A start has been made as a repository
identify triggers for early detection. The fraud monitoring has been formed in 2016. About 43 insurance companies
function needs to be instrumental in identifying vulnerable have come together and have appointed credit rating
and susceptible areas in their customer association to agency Experian in order to use Experian's big data and
identify triggers to detect fraud. According to a FICCI report analytics capabilities. Fraudulent behaviours are rapidly
common triggers observed to detect frauds are: evolving as fraudsters are becoming more intelligent,
Claim from a policy with only one member at minimum proficient and adventurous in the digital space. When
sum insured amount. fraudulent behaviors and technologies are rapidly evolving
- optimizing analytics and building an adaptive analytics
Multiple claims with repeated hospitalization and
strategy is key to success.
multiple claims towards the end of the policy period,
close proximity of claims.
Life Insurance Frauds
Any claims made immediately after a policy sum insured
enhancement. Anurag Joshua (name changed) received an email from his
insurer that a good amount of maturity amount on his
Claims from a member with the history of frequent
insurance policy is due. The concerned person in the mail
change of insurer or gap in the previous insurance policy.
asks Joshua to deposit some TDS amount before the
Policy claims with evidence of significant over/under company transfers the maturity amount. Joshua does it only
insurance as compared to the insured's income/lifestyle. to discover that it was a hoax. Someone had created a fake
Claims from a non-traceable person or where courier/ email ID to dupe him. There are multiple cases when people
cheque have been returned from insured's documented produce fake death certificates to receive the life insurance
address amount.
The second claim in the same year for an acute medical
illness/surgical minor illness/orthopedic minor illness in
the same policy period for main claim. Young males
between 25-35 years getting admitted for acute
medical illness
Claims from members with no claim free years, i.e.
regular claim history

It is the need of the hour to have laws that can provide swift
recourse against such frauds. In today's scenario, stringent
laws and strict punishment are required for those guilty of
having committed these frauds which will also act as a
deterrent for others looking to exploit this industry.
Insurance entities continue to curtail fraud, yet a lot needs
to be done to make the existing framework more robust and

38 The Insurance Times, October 2022