OLKATA: Insurers and the Insurance Regulatory Development Authority (Irda), for the first time, have begun to protect and share a database of hospitals involved in frauds. Insurers have also started to maintain an informal network of customers found to be indulging in wrong doing, which they have started to circulate among themselves. “It has been predictable that false claims in health insurance is estimate the universal insurance segment `600 crore every year about 10-15% of the total claims paid. The section has seen very high claims ratios which, coupled with deceitful claims, have become a matter of concern for insurers,” said BS Powdwal, head of Bajaj Allianz in General Insurance. The main frauds in affordable health insurance pertain to overstating claims or occupy manipulate documents of non-existing hospitals, pharmacies etc or to cover-up non-disclosure of facts at the proposal stage. It has been seen that hospitalization benefit policies and personal accident policies are more subject to frauds. Research reports claims say that 20-30% customers exaggerate their loss since they think that insurance companies will always pay lesser than what one claims, even if the injure assessment is true. Management of document is one of the ordinary means of fraud in the segment. India Forensic Research states that medical bills are the most commonly forged documents. There are also instances where a policy is taken in the name of a customer without their information. These are more widespread in group policies.
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