IRDAI’s Initiative on frauds in insurance for Frauds in Insurance

Anti-Fraud Policy : All insurance companies are required to have in place an Anti-Fraud policy duly approved by their respective Boards. The policy shall duly recognize the principle of proportionality and reflect the nature, scale and complexity of the business of specific insurer and risks to which they are exposed. While framing the policy, the insurance company should due consideration to all relevant factors including organizational structure, insurance products offered, technology used, market conditions, etc. As fraud can be perpetrated through collusion involving more than one party insurers should adopt a holistic approach to adequately identify, measure, control and monitor fraud risk and accordingly lay down appropriate risk management policies and procedures across the organization. Important aspect of Anti-fraud policy to include procedure for fraud monitoring, identification potential areas of internal fraud, policyholder fraud, claims fraud, intermediary fraud, coordination with law enforcement agencies, framework for exchange of information, due diligence, regular communication channels and fraud monitoring and preventive mechanism.

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