Wednesday, August 7, 2019, 11:47 AM
Private sector insurer ICICI Lombard is using artificial intelligence (AI) and machine learning to not only improve claims processing and settlement but also to detect frauds in segments such as motor and health insurance. “We use machine learning to figure out when the surveyor is assessing motor claims to see which parts are outliers. Auto parts are priced differently across the country, but in case some garage charges very high, the algorithm can throw it up. It shows anything which is 5% too high or too low as an outlier,” Girish Nayak, Chief of Customer Service, Operations and Technology said. Similarly, in the case of medical claims, the insurer is using machine learning AI to check if a hospital may be sending claims for a particular illness at a particular price. “In such cases, you know there is something wrong and you send someone to check it. This can increase efficiency and help detect frauds better,” Nayak said.
Monday, July 8, 2019, 7:26 PM
The Haryana Police arrested a gang of fraudsters for fraudulently claiming insurance money from 25 companies by misrepresenting cancer deaths as accidental deaths. The fraudsters had raised multiple insurance claims and around 100 were under process. They allegedly carried the dead bodies of the cancer patients from their homes and influenced doctors, insurance agents, and enquiry officers. They took the bodies of cancer patients to the accident spot to pass them off as genuine deaths in accidents, and to hospitals where autopsies were carried out. Criminals would identify terminally ill cancer patients from rural and low-income backgrounds, get them to insure themselves with different insurers by hiding their health condition, wait for them to pass away and then put cause of death as ‘accidents’. The fraudsters would keep the bulk of the insured sum, (This is around Rs 8 Lakh to Rs 20 Lakh), and distribute the remaining amount with partners, police officers, family members, record keepers, insurance agents, doctors, and public prosecutors.
Thursday, July 4, 2019, 7:04 PM
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