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Suggestions On Insurance Claim Verification In China

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  • SBCS
    Dear colleagues, Insurance fraud is becoming more and more rampant in China. Based on our experience in insurance claims investigation, we input the following
    Message 1 of 1 , Nov 3, 2006
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      Dear colleagues,



      Insurance fraud is becoming more and more rampant in China. Based on our experience in insurance claims investigation, we input the following suggestion on insurance claim verification in China for your reference.



      Suggestions On Insurance Claim Verification In China



      In recent years, with the popularity of insurance, common people acquire more and more knowledge of it in China. It stimulates the development of insurance industry as well as brings new risks to insurance companies. Through communication with Chinese insurance companies, we learnt that a new phenomenon had already emerged in some regions of China that the insured or their relatives conducted insurance fraud in cahoots with medical departments, and was increasing rapidly. It is advisable for international insurance company to attach importance to it.



      The insurance company usually emphasized on the verification of the insured’s illness and treatment with hospitals and doctors, and we conducted the verification based on the requirements of insurance companies, but not limited to their requirements.



      At present, however, neither perfect social credit system nor records of individual’s credit status has been established in China, and in some regions, there are holes in the supervision of the governmental authorities on medical departments. Thus, with the popularity of insurance, tempted by large amount insurance claim, the insured or their relatives are in cahoots with doctors and hospitals to make false death certificate, diagnose certificate, or make illusive introduction of illness and medical treatment to insurance companies, then obtain the insurance claim by fraud. Under such circumstance, the investigation results cannot be effectively guaranteed only by interviews with the related doctors and hospitals.



      Based on the above analysis, we suggest conducting field investigation or verification with the local basic governmental departments, funeral departments, especially the verification with the insured’s neighbors, and analyzing the information obtained from different sources in insurance claims verification.



      Any suggestions or comments are welcome.



      Best regards,



      Margaret Wan

      Consultant of Risk Control Department
      --
      President: Hai Yang
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