Things you should watch out for in insurance claims

Insurance companies in India are witnessing a massive increase in fraud claims. There are cartels of fraudsters in operation, who sometimes resort to threatening or physically abusing the field investigation officers. There have been many cases where the claim investigation officer has been either forced to give a clean statement or was offered bribes to approve the claim. 

Many insurance companies have reported instances of theft of customer database by fraudsters to make fake claims using forged documents. This is a serious offense that can lead to years of imprisonment if convicted. 

Several insurance companies in the US and Europe use a series of data analytics to identify transactions and processes that require a closer scrutiny. In India, the data analytics company Experian is now building a similar data repository and a fraud-monitoring framework in association with the Life Insurance Council of India. 

Claim protection under the Insurance Laws (Amendment) Bill 

As per the recently passed Insurance Laws (Amendment) Bill 2015, an insurance policy cannot be challenged on any grounds in connection with the claim settlement after three years. This means, if the policy has been in force for three years, the insurance companies will have no choice but to pay the policyholder.
Insurance companies object to this policy due to the increasing number of fraud cases. However, genuine claimants who were unable to get their claims cleared for reasons that looked suspicious to insurers can hope to get their claims without being branded scammers. This also helps claimants to save time by avoiding long claim disputes at courts. 

The bill calls for more watchful processing of insurance applications by companies, as well as strict norms on claim inspection to close the case within the shortest possible time. Tips to make a successful life insurance claim Following tips can reduce your chances of having your claim denied or your claim being bracketed as a fraudulent one: 

•    Send the claim intimation to the insurance company as soon as possible. Any delay in communication can make the insurance company suspicious about the claimant.
•    Make sure that the claim intimation has all the relevant information including the name of policyholder, date, place, and cause of death, and any other pertinent information required by the insurance company. Hiding any information or sharing incomplete information can lead the company to feel insecure about your claim.
•    Attach supporting documents like hospital certificate, police FIR, post-mortem report, etc., if applicable, to make your case more genuine.
•    Ensure not to give wrong information or suppress lifestyle habits like drinking, smoking, etc., or pre-existing diseases while applying for insurance. Insurance claim frauds are on the rise and insurance companies are focusing their attention on eradicating this menace. Always file your claim in a clean and transparent manner to avoid your genuine claim being rejected.

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