How fraudulent claims hit insurers...and you
SummaryIf what stakeholders say is true, the industry could be losing a billion dollars to health insurance fraud
In May, a Navi Mumbai resident’s family bought a personal accident policy in his name from Aditya Birla Health Insurance Company (ABHI). While that in itself is a perfectly routine transaction — hundreds of people do so every day — there was a catch. The man who was insured had died of natural causes a few days earlier. After a month or so, the family lodged a ₹50 lakh claim saying that he had died in an accident. But the elaborate scheme failed, says Mayank Bathwal, the insurer’s chief executive officer. “We got hold of the original death certificate and could figure out that the policy was issued on 17 May, while the death had occurred on 13 May."