Kathmandu. About 6 months ago, a death claim application of Rs 50 lakh was filed in the office of a life insurer. After the claim was registered, the employees of the claims department started examining the documentary evidence received along with the claim application. While examining the paper evidence, it was initially suspicious. They based suspicion on the information that the insured had died at home within 6 months of paying the first installment. <\/p>\n
Then started the investigation of the documents from the insurance policy proposal of the insured. During the investigation, it was found that the insured had a legitimate source of income. It was found that he was earning regular income from the business and also paying regular taxes. It was found that the insured was able to pay the insurance premium. Later, when the documents were turned over to know the cause of death, the staff of the claims department did not find the treatment papers. <\/p>\n
The fact that the insured died within 6 months of the purchase of the policy, the lack of treatment papers and the specific cause of death was not revealed, now the claim department like the Nepal Police became active for further investigation. In the meantime, there was constant pressure from the insured to expedite the payment of the claim citing financial crisis and absence of guardians. <\/p>\n
After not finding satisfactory evidence and grounds during the paperwork, the Claims Department decided to depute the representative of the branch office to the house of the deceased for field investigation and on the basis of the instructions, the branch deputed the staff. The employee submitted a report with the conclusion that the insured had been resting at home for a few days before the death and had died when his condition was normal. Even after this, the experienced staff of the claims department was not satisfied. <\/p>\n
They decided to go for the on-the-spot investigation on their own and reached the village of the deceased without prior information to the branch and the concerned agent. They duled, had tea, had lunch. They looked at the condition of the house and shop. The condition of both of them indicated that the insured was not in a position to pay a large amount of insurance premium regularly during the year. And the employees started chatting with the neighbors in the tea shop. <\/p>\n
While talking, they found out that the person was a chronic patient and that he had been going across the border to the Indian market and getting regular treatment in the same hospital. However, due to the lack of concrete evidence to prove the treatment of the insured with the insured, they were forced to proceed with the claim process. And before paying the claim, they decided to send the claim documents to the reinsurer for their opinion. <\/p>\n
Now here is the twist in the story. The reinsurer immediately sent a response to the insurer through e-mail and informed that life insurance was also done in 4 other life insurers in the name of the deceased insured. The insurer had given life insurance to a total of 2 crore 20 lakh insured in 5 companies. The employees of the claims department were shocked when the reinsurer sent the information by revealing the name of the insurer and the details of the actuary. Now their initial suspicion was confirmed, but due to lack of evidence, the insurance claim could not be stopped. They were forced to forward the claim payment documents helplessly. <\/p>\n
In all these cases, the absence of the Insurance Information Center was one of the major reasons. The insured should self-declare whether the life insurance is in the other insurer at the time of filling up the life insurance proposal. The details should be given. However, the deceased insured did not mention any such information to another life insurer in the proposal form. <\/p>\n
If the Insurance Information Centre had been set up, it would have been easier for the insured to decide whether the other insurer of the insured had life insurance before the proposal was approved, whether the insured had the capacity to pay the premiums regularly for all the life insurance. It would have been easy to take the decision to reject the proposal when the proposal to purchase the insurance policy of the insured was initially suspicious in excess of his income source. <\/p>\n
There is a provision everywhere in the law, but the authority is asleep like Kumbhakarna<\/strong><\/p>\n In the absence of an insurance information center in Nepal, the tendency of fraud in the insurance sector has given rise to the tendency of insurers and claimants. In the absence of a common means of information exchange i.e. Insurance Information Center, the insurers themselves have to spend more time, resources and manpower in collecting facts, figures and important information about the insured and the subject matter of the insurance. Also, since such information is not available in an integrated manner, the insurers are forced to do both risk assessment and insurance claim settlement on the basis of inadequate and weak information. <\/p>\n The Insurance Act 2079, Regulations 2081, National Insurance Policy 2080, Second Insurance Strategy 2023-2027, Annual Policy and Program (2082). 83. The provision for the establishment of the Insurance Information Center and the time limit for the establishment of the Insurance Information Center have also been prescribed. Although the issue of setting up of Insurance Information Center has been included with priority in all these legal and policy documents, the Insurance Authority has not implemented it. <\/p>\n Section 155 of the Insurance Act provides for the establishment of an Insurance Information Center under the Nepal Insurance Authority. This Act has come into effect from October 2079. Section 11 of the Act provides that the Insurance Authority can establish an Insurance Information Center to collect, integrate and manage the information of the insurance sector. The Authority shall regulate the Information Center. <\/p>\n Similarly, Rule 108 of the Insurance Rules, 2081, which came into effect from February 2081, provides for the establishment of an Insurance Information Center. The Insurance Information Center established by the Authority pursuant to Section 155 of the Insurance Act is scheduled to perform the following functions: <\/p>\n (a) Collection, storage and distribution of insurance information. <\/p>\n (b) Committing an insurance offense including insurance fraud, fraud, forgery or forgery or committing an unnatural or suspicious insurance <\/p>\n (c) To be blacklisted or placed in the list of suspects, <\/p>\n (d) To collect and record the information referred to in Sub-section (4) of Section 143 of the Act, <\/p>\n (e) To prepare periodic reports relating to insurance, <\/p>\n }<\/p>\n (f) To collect other necessary data relating to insurance, <\/p>\n (g) To carry out activities in accordance with the objectives set forth in the Memorandum of Association and Articles of Association of the Centre. <\/p>\n (2) The insurer shall provide to the Insurance Information Centre the details, information and information necessary to perform the functions referred to in Sub-rule (1). <\/p>\n In addition, the Second Insurance Strategy (2023-2027) had set a target to set up an Insurance Information Centre by 2025. Stating that it is necessary to increase the credibility of the public in the insurance sector and to make information exchange effective, the strategy reads, “It is necessary to establish Insurance Information Bureau, to aid in the efficient operation of the insurance sector by providing complete, consistent, and concise information support to members of the Society and all other stakeholders associated directly or indirectly with the insurance sector. (The establishment of an Insurance Information Bureau is necessary to provide complete, stable and accurate information support to the members and stakeholders of the society directly or indirectly involved with the insurance sector. )<\/p>\n Annual Policy and Program of Insurance Authority 2082. Policy No. 83 8(e) The policy related to research-based policy making, insurance account development and delivery of quality services also mentions the establishment of an insurance information center. <\/p>\n Policy No. 9.5 of the Insurance Policy of the Government 2080 9.5 To promote institutional governance in the insurance sector, to control fraud and fraud in the insurance sector and to establish the Insurance Information Center under the institutional arrangement. 11 mentions the establishment of an Insurance Information Center under the institutional arrangement.<\/p>\n","protected":false},"excerpt":{"rendered":" Kathmandu. About 6 months ago, a death claim application of Rs 50 lakh was filed in the office of a life insurer. After the claim was registered, the employees of the claims department started examining the documentary evidence received along with the claim application. While examining the paper evidence, it was initially suspicious. They based […]<\/p>\n","protected":false},"author":16,"featured_media":318388,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[45031,45167,45067,45159,45156],"tags":[],"class_list":["post-318417","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-banner-news-en","category-technology-en","category-important-en","category-news-en","category-blog-en"],"acf":[],"_links":{"self":[{"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/posts\/318417","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/comments?post=318417"}],"version-history":[{"count":1,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/posts\/318417\/revisions"}],"predecessor-version":[{"id":318418,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/posts\/318417\/revisions\/318418"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/media\/318388"}],"wp:attachment":[{"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/media?parent=318417"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/categories?post=318417"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/insurancekhabar.com\/ikbrapi\/wp\/v2\/tags?post=318417"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}