Insurance Claim Investigation

 SPECIALIZED IN DEATH CLAIM INVESTIGATION :

Our company began to train insurance investigators in the year 2006 to handle insurance frauds investigation among corporate sectors and built its  network all over India and abroad and began handling  nearly 60 cases a year with  cent percent accuracy in handling fraud cases in Insurance claims investigation.

Our company began to build a team base in various districts from the major cities and interior districts to provide field checks, field investigation, and to monitor within the given TAT.

Standard of procedure for fraud investigation

Internal Standards :

When a particular case is sent to us for investigation, the case with all relevant details inclusive of documents given has to be formally sent to the following e-mails only on priority basis, the same will be acknowledged within 24 hrs.

A data bank of the total cases with regard to status updates of cases to client with reference to pending status, completed status, address required, wrong address, etc

External standards

The cases will be forwarded to Investigation Officer who in turn will forward to field officers who segregate area, regional & district wise, and cases will be forwarded to the field investigators to conduct investigation. Once a report is generated from the field to the analysts, each cases will be checked of their quality & authenticity of information which are generated from the field investigators based on a Standard formatting procedure (SOP) for collecting information and documentation

A team of field analysts & Data entry operators will verify the given data based on the format of procedure to look into any discrepancy, loop holes, fraud, and lack of proof to support the final conclusion of the case.

SOP FOR FRAUD INVESTIGATIONS

(General Investigation)

  1. Names and addresses of the persons of whom enquiries were made and information may be obtained from LA’s relatives, neighbours, colleagues, friends, doctors, hospitals
  2. Deformity, peculiarities etc. in the physique, health and habits of the deceased discovered during the enquiry (the deformity or peculiarities etc. referred are what are noticed by or as per the knowledge of neighbours, Deceased person circles etc.)
  3. Insured person’s occupation and average monthly income.
  4. Relationship, if any of the life assured with the any ICC, any STM and any Medical Examiner and whether any of them has got a pecuniary interest in the claim amount.

(Medical Investigation)

  1. Details name and address of deceased’s usual medical attendant / family doctor during past 3 years.
  1. For his/ her last illness (mention the period of hospitalisation, name /s of the doctors attended and IP/OP No.)
  2. Collect the certified extracts or summary from the records maintained by the doctors.
  1. Whether the doctor had treated the deceased for the same or any other ailment any time before the date of commencement / revival of the policy and if so, for what ailment and how long
  2. State the names and addresses of doctor who directed him/her to go to hospital, and whether any letter of introduction is available
  3. Details of any routine examination like X –Ray, Blood, Urine Test, ECG or other special medical reports prior to Date of Commencement of policy.

The following documents will be collected on field with particular reference to CHECK the authenticity and veracity for the death claims applied for among neighbors/friends/relatives/doctors, etc.

  • DEATH CERTIFICATE
  • STATEMENT FROM NEIGHBOURS
  • FAMILY RATION CARD
  • VOTERS ID OF LA & NOMINEE
  • LETTER FROM PANCHAYAT
  • LETTER FROM DOCTOR OR HOSPITAL DOCUMENTS TO SUPPORT FOR NEGATIVE CLAIMS
  • FAMILY PHOTO
  • AGE PROOF
  • PHOTOGRAPH OF BURIAL GROUND