Page 250 - Ebook health insurance IC27

The Insurance Times

carefully verified since the insured may do it intentionally after suffering from
any disease which may require higher costs of hospitalisation.

C. Health checks undergone
Some policies reimburse the cost of health checkups.
It must be verified carefully whether insured has undergone actual checkups. They
may submit false report for claiming the health checkups amount.

Fraud during the claim settlement stage

Most of the fraud occurs during the claims stage.

The possible cases of fraud at claims stage are summarised below
A. To seek benefit

Object of health insurance policies reimburse for any medical expenses. However
sometimes even if there is no claim the policyholder may file a claim just to get the
benefit of the policy.

B. Erroneous address to claim benefit
Just before making the claims the insured may change the address so that the fraud
cannot be traced.
Ask for Know Your Customer Norms

C. Inflation of medical bills
 This is the most common fraud in health insurance
 Most of the insured try to inflate the bills to get more benefit.
 There is a strong nexus between health insurance provider i.e hospitals, doctors and

the customer.

254 Guide for Health Insurance