Clients Success Stories

Partnering Indian Life and Health Insurance Companies to create a unique Doctor Relationship and Validation process.

Client: One of India's leading Life and Health Insurance companies

Challenge A leading Indian insurance company was facing fraud and thereby losses in its pre-policy medical check up process. In case of life and health insurance, medical check up is an important basis for underwriters to ascertain the risk in insuring a person. In certain cases agents in collusion with few doctors either manipulate or withhold critical results of a medical check up. This leads to incorrect assessment of risk and ultimately losses for the insurance company.

Solution CRP devised and implemented an investigative exercise to uncover the fraudulent elements in the doctor and agent network. CRP deployed some of its employees as insurance seekers. Their investigation modus operandi was to request the insurance agent and/or the empanelled doctor to manipulate or withhold certain important information about their medical condition that could lead to policy rejection. After carrying out a thorough probe, CRP furnished a detailed report on miscreant doctors and agents to the insurance company. Post-weeding out, CRP now provides periodic checks on the doctor and agent network.

Advantage CRP's service has eliminated the risk elements in the medical check up process. This has trimmed the insurance company's losses arising out of incorrect assessment of medical risk. A periodic screening of empanelled doctors and agents ensures risk identification and elimination on a continuous basis.