Our Services to Insurance Company

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Fraud in Life Insurance

Life Insurance is common way of ripping off insurance company. Frauds can be committed by anybody, policyholder, a healthcare provider or even its employees.

Frauds nowadays have become easier and more accessible, as Fraudsters are aware about the procedures and severity, and the legality involved in it.
The fraud ratio is increasing day by day as there is limited scope of steps taken by the insurance company which is limited to only termination and so the fraudsters have become fearless.

Fraud in General Insurance

Making inflated bills.

A policy is purchased using another's details to gain more favorable term like fake policy.

An individual or group, who set up policies for members of the general public, deliberately misrepresenting themselves as an insurance broker, agent or insurer for profit.

False involvement of the vehicle in the MACT claims.

Involvement of habitual driver in fake accident.

Services

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Investigation Services offered to Life Insurance Company

A.  Claim Investigation

B.  On Field Investigation

C.  Data Analysis

D.  Cyber Investigation

E.  Seeding and Mystery Shopping

F.  Investigation in M.A.C.T. Cases

G. Forensic Investigation

H. Legal Services

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A. Claim Investigation

  • Medical claim (Cashless, Reimbursement, Intimation)
  • Death/disability/injury claim under MPA/MACT cases.
  • Critical illness policies.
  • Death/TPD claim under PA/GPA/IPA policies.
  • Worker compensation claims.
  • Mass Health policies.
  • Life Insurance.
  • PMJJY Verification

B. On Field Investigation

  • Pre claim and Post Claim Fraud & Risk Identification Services
  • Background Check
  • Profile Verification
  • Document Authentication
  • Field Survey
  • Claim Investigations
  • Detective Services
  • Property Search & Verification
  • Live & Death Claim Verification

C. Data Analysis

  • New Business Login
  • Policy Servicing Activities
  • Empanelled Medical/Diagnosis Centre
  • Payout and Refund Analysis
  • Claim Analysis
  • Branch Audits
D. Cyber Investigation
  • Email investigation,
  • Web Investigation,
  • IP Address Investigation,
  • Cyber Crime Investigation,
  • Investigation of Intellectual Property Right Like… Copy Right
    Patent
    Trademark Design
E. Seeding & Mystery Shopping

Medical/Diagnosis Centre

Suspected Branch

Branches having High Claim Ratio

Suspected Agents Internal Process

Occupational Fraud

F. Recovery & Arbitration

  • Fraudulent Surrender
  • Fraudulent Death Claim
  • Cheque Misappropriations
  • Premium Siphoning
  • Employee Settlement Dues
  • Advisor Commission Recovery

Critical Health / Dead Man Insurance: Modus Operandi

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Organized fraud in Dead Man Insurance Case

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Work Area / Location

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Why Legal action needs to be taken?

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Why Legal action needs to be taken?

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