Page 249 - Ebook health insurance IC27

Sashi Publications

Following disclosures must be studied carefully to find out fraud:-
i) Disclosure of health status at the time of medical examination

The individual must inform the exact medical condition to the examiner. There are
many diseases like hypertension which cannot be assessed through medical reports.
It is the duty of the proposer to disclose all information correctly.

ii) Impersonation
If a person suffering from disease he will not be granted health insurance has he may
ask any other person to appear for medical tests on behalf of him. The medical
centre should check authentic ID proof of the proposer.

iii) Manipulation of tests/records
Sometimes when proposers don't agree to turn up for medical tests, the agents in
order to get the business manipulate test report of some other person in collusion
with the doctors. This must be verified carefully

C. Cash defalcation
This means cash may be accepted from the proposer but it is not deposited in the
insurance company. This is generally done by the intermediaries who accept the cash
for depositing the premium but ultimately failed to deposit

Fraud during the contractual period

A. Address and contact details change
If any policyholder ask for change in address only few days after taking the policy it
should be verified whether it is genuine or not.

B. Sum assured alteration
If the insured changes the sum insured during the period of the policy it must be

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