HEALTH INSURANCE CLAIMS

 

Insurance frauds have become and order of the day, as some agents and even the public has devised new strategies to dupe the insurance agencies.

For detecting insurance frauds person should be highly active brain with study of criminal physiology and moreover one shall have good team work and proper intelligence network. 

MEDICAL INSURANCE

Fraud claims in medical insurance are always pre-planned , any such person intend to  fraudulently claim the insurance make all his plans in connivance  with his agent or by himself.

OUR CASE ANALYSIS

We had been investigating such false claims and found that modus operandhi of such claimants is full proof.
The cases which our bureau experienced and detected in subsequent years as mentioned below:-

2007-2008: 3

2008-2009:31

2009-2010:22

2010-2011:36

2011-2012(July):14

OUR INVESTIGATION EXPERIENCE

It was noted that claimant has requested cash less claim in the hospital for a tune of Rs 3 Lakhs for accident , the said policy was medical policy 8 months old when the highly alert and conscious insurance company suspected the foul play and immediately engaged our  bureau , this was a land mark investigation for our bureau as the said fraud was detected with in 48 Hrs of investigations.

Our investigation revealed that accident taken place was genuine and after discreet perusal of records in hospital and other enquires we found that patient was suffering from Heart Disease since 2 Years and trying to convince the doctors avoid writing anything of their previous medical history on case sheet.

We immediate took cognizance of this situation and collected the evidence discreetly from the hospital about the false information of previous aliment of party and furnished the same to our clients.

The insurance company declined to pay the amount learning about the false information provided by the party at the time of application as per their company policy.

The party accepted their mistake and never pursued the claim legally with our clients company.

ADVISORY

The clients are advised to undertake such investigations immediate without delay

REQUIREMENTS OF INVESTIGATIONS

  1. Letter of entrustment
  2. All the minute details of case

TIME FRAME WORK

Depends upon the clues provided and progress of case minimum days range from 15 to 30 days.

 
 
© third eye intelligence bureau. co. in 1996 - 2012