Petaling Jaya: Bleeding from staggering claims, most insurance firms have now set up special anti-fraud units comprising specialised investigators to scrutinise claims.
Prudential Assurance Malaysia Bhd chief executive officer Charlie E. Oropeza said suspicious cases or those that involved large payouts were referred to the officers from the units who were well-trained to detect wrongdoings.
“The company will then make an informed decision on whether to pay the claims based on the findings from our detailed investigations.
“But having said that, it is important for people to know that as an insurance company, we are here to pay claims and will do it in a fair and equitable manner,” he said.
Oropeza said clients would ultimately have to pay expensive premiums if they made frequent or large claims.
On the extent of insurance fraud at the company level, he said: “We are unable to disclose the details but rest assured that it is within our expected tolerance level.”
He said Prudential also provided training and held regular meetings with its agency force to weed out fraudulent claims.
“The agents are our first line of defence and have a better insight into cases,’’ he said.
Without disclosing the quantum of fraudulent claims, Great Eastern Life Assurance Malaysia Bhd senior vice-president and head of risk management/compliance Cheong Soo Ching said the company had in place “robust” mechanisms to fight fraud and these were constantly refined and fortified.
“We also have an experienced team comprising well-trained professionals to handle fraud matters. They are entrusted with monitoring work and to detect any unusual trends or patterns,” he said.
To keep abreast of fraud risk developments, Cheong said Great Eastern constantly updated its staff and agents with risk awareness programmes.
“We also initiate discussions with them on how to improve on measures to check fraud. Regular analyses of cases are also carried out,” he said.
Lonpac Insurance Bhd adviser Tee Choon Yeow said: “Occasionally, we do come across fraud cases where claims are inflated or falsified. However, such attempts are under control because we have in place an efficient claim evaluation unit.”
The Star 15th January 2011
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