Fraudulent claims pain in neck for firms

Insurance coverage for job loss is a policy that covers the insured only, in case of getting terminated from a job due to merger or acquisition for which a certificate of termination from the employer, mentioning the cause, a copy of last three months’ sa

Recently, fake claims have been rising causing a pain for Insurance companies. One such case that came up recently was that of a person who claimed that he was working as an accounts manager with an Overseas Education consultant.

Mr Ravi Kumar had claimed for insurance under the category ‘loss of job’. Ravi, in his submission, furnished a termination letter for the claim.

Upon receiving the claim request, the Insurance Investigator called Mr Ravi. But he refused to turn up stating that he had submitted all the required documents.

As part of investigation, officials visited an address in Jubilee Hills which Ravi had mentioned as his residence in the claim, but to their surprise, no one by this name had resided there, which increased suspicion.

According to Ravi’s claim , he along with his friends were travelling to Hubli and they met with an accident, resulting in grave injuries and thus his office terminated him from service .

Investigating officer S. Rahul told this newspaper that a team visited the insured workplace. “We found only six employees in that organisation and that does not include Ravi. The fact is that Ravi never worked in the Consultation Company. But his relative was one of the directors of the Company and upon his request, the company fabricated the documents and issued a termination letter with a motive to claim an insurance sum of `35,000. Another claim that was proved wrong was that he is a resident of AP and not Hyderabad and misled the investigators,” the investigating officer said.

Insurance coverage for job loss is a policy that covers the insured only, in case of getting terminated from a job due to merger or acquisition for which a certificate of termination from the employer, mentioning the cause, a copy of last three months’ salary slip, appointment letter etc. have to be submitted as proof.

An insurance fraud investigator has detected many fraudulent documents in this claim from Hyderabad.

Another case was of a 26-year-old T. Sravani, an employee who allegedly worked with a trading company.

An officer Karunakar who detected the graft explained that Sravani (insurer) in her claim mentioned that she had joined a Trading Company in Hyderabad in 2016 as an Executive in Quality Control for a net pay of `17,700/- per month.

“But she got terminated from the services a year later, as the office shut down the Quality Control wing. On visiting the office premises, it was found that the whole company was operating in a single godown-cum- office and the owner Hanumanthu stays on the first floor. The original owner failed to recognise the claimant and Sravani’s cell phone was out of reach. On further inquiries, it was found that she was an executive working with a pharmacy company. Both Sravani and husband S. Kiran who is a partner in a distribution agency confessed that they fabricated the salary slip, company name, termination letter and all other documents, without the knowledge of main director Hanumanthu, whose company was mentioned in the claim,” the officer said.

Speaking to this newspaper, a senior officer from the insurance company said:“In few cases, we found that the claim was raised when the insurer gets terminated based on poor performance, voluntary resignation due to pre-existing diseases and health conditions or disciplinary action. The claim does not cover these reasons and thus get cancelled”.