i was not joking when i said how proper governance only can be a solution to the perennial problems of money drain through frauds
shailesh shah
I have repeatedly found in your public notices and circulars that the
data published is self validated by the insurers only. - that means
you have done the work of a peon only with no extra intelligence put
to use. It is like giving the reigns in the hands of suspect ( though
not all insurers are suspect some of them do fall in the list and also
the same insurers may behave in different ways in differing
circumstances- so let us not keep too much extra unwarranted faith in
the information being shared by insurers).
.
There is a greater need for india to come up with its own SFU Special
Fraud Investigation team for insurance frauds, where there is
representation from all concerned including surveyors. Then only
Governance will have some value, or else it will simply remain as
paperwork with no realtime use in curbing the country's economic
upsets.
I assure you that if sufficient steps are taken up on warfooting basis
with good planning, country will have surplus money to bring down the
prices of essential commodities in the country without any subsidies
from Finance Ministry.
this is reprinted from a very authentic source in U.S.A.
Editorial
How to Reduce Insurance Fraud
=====
I propose the following methods to reduce insurance fraud because, for
some reason unknown insurers, state prosecutors, federal prosecutors
and the Departments of insurance either don't understand or don't want
to understand what is needed. These are my suggestions:
1. Insurers should adequately staff and train its Special Fraud
Investigation Unit (SIU).
The SIU should train all claims staff to recognize the red flags of
fraud and how and when to refer a suspected fraud to the SIU.
2. The SIU should thoroughly investigate every claim reported to them
as a suspected fraudulent claim.
3. Every claim where evidence exists that arouses suspicion that a
fraud is being attempted should be reported to the Fraud Bureau, Fraud
Division, States Attorney, District Attorney or Attorney General
depending upon state law.
4. Insurers that discover the existence of a preponderance of the
evidence that a fraud is being attempted must deny the claim
unconditionally.
5. When a claim is denied the insurer must stick to their decision
and defend, through trial every suit brought by an insured.
6. When an insured or claimant is arrested the insurer, and its
staff, must make clear to the prosecutor that they are available to
testify and are interested in the prosecution.
7. When an insured or claimant is convicted of insurance fraud the
insurer should provide the court with evidence of the costs incurred
and demand restitution.
8. When the insurer defeats a lawsuit brought by an insured against
it, it should demand all costs incurred from the plaintiff.
9. When the insurer defeats a lawsuit brought by an insured it should
consider filing a suit for malicious prosecution if counsel advises
such a suit is available.
In simple words an insurer should make it clear to the public that it
will not tolerate fraud and will fight any fraud it believes was
attempted against it to the highest court available and will also do
everything possible to see the fraud perpetrator punished civilly and
criminally.
--
Shailesh B. Shah
Insurance Surveyor / Loss Assessor
Vadodara Cell- 9824021192
www.insurance-surveyors.com
Vinod Sabharwal
From: shailesh shah <shaile...@gmail.com>
To: ypriyab <ypr...@irda.gov.in>; TS Naik <tsn...@irda.gov.in>; chairman <chai...@irda.gov.in>; pchander <pcha...@irda.gov.in>
Cc: Hon'ble Prime Miister of India Dr. Man Mohan Singh <pm...@pmo.nic.in>; fm <f...@nic.in>; insurance_surveyors <insurance...@googlegroups.com>; gicouncil <gico...@gicofindia.com>
Sent: Tue, 16 February, 2010 11:23:44 AM
Subject: {Surveyors:4019} i was not joking when i said how proper governance only can be a solution to the perennial problems of money drain through frauds
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