CASE STUDIES

A claim application was received from a well-known insurance company. Our Team of professional doctors and field executives reviewed thoroughly the submitted documents and it was understood that the submitted documents were fake in order to get the benefit of insurance amount.

We recd the claim of the patient for the RTA (Road Tariff accident), Our Doctor and team review the documents and found that patient had purchase the policy in recent and after 20 days patient has met with the accident. Visit was conducted at patient’s residential address to understand the scenario of his case and met with the patient and collected the patient statement. And Inquired him Exact incident and Patient confirmed the entire incident and we collected all medical documents and Patient statement. We checked patient Google time and found that at at DOA patient was on another place, we checked Google time of before 2-3days of accident and he got a clue that patient visited at the Diagnostic centre, before purchasing the policy. Our FO and Doctor did cross question to the patient but he was not ready to say the truth.

Major challenge is to understand the nexus of hospitals that are helping out the patients to make such fake documents in order to pass the claim. To understand the reality on ground and corroborate the same as per documents submitted by the patient.

The insurance company was prevented with a fraud of INR 1.5 Lakhs which was going to occur if any negligence would have been done in the investigation.

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