Bajaj Allianz General Insurance Uncovers Health Insurance Claim Fraud by Employees – Files FIR

Pune, 12 June 2024: Bajaj Allianz General Insurance, one of the leading private general insurers in India, uncovered a case of health claim fraud orchestrated by four of its employees. The employees involved in this fraudulent activity are Rohan Galande, Shubham Shewale, Madhukar Kamble, and Vijay Thomas. These individuals, who had been with the company for a considerable period and were well-versed in the health claim processes, meticulously planned and executed a conspiracy to defraud the company. The company has taken swift action to terminate the employment of the accused and has filed a First Information Report (FIR) against them.

The fraud took place during the COVID-19 pandemic. Following the IRDA guidelines, various COVID care policies were launched by insurance companies, including Bajaj Allianz General Insurance, to assist the public during these trying times. Due to the pandemic and the need to expedite support, Bajaj Allianz General Insurance processed claims swiftly to ensure timely assistance to policyholders. The accused held positions within the company’s health claim processing team and exploited the unprecedented surge in claims and relaxed regulations. The fraudulent scheme involved the purchase of health policies for friends and relatives of the accused. These employees had access to treatment papers, internal documents, and hospital documents from across India. They submitted fabricated medical claims on behalf of fake policyholders, bypassing critical system checks due to their insider knowledge defrauding the company of claims mounting INR 2.23 Crore.

Bajaj Allianz General Insurance, committed to maintaining robust claim scrutiny procedures, identified inconsistencies during a post-pandemic review. Upon contacting hospitals associated with the suspicious claims, it was confirmed that the ‘admitted’ patients had never been treated at their facilities. Further investigation revealed a pattern: all the fabricated claims were processed expeditiously, bypassed standard checks, and involved the accused employees. Confronted with this evidence, the accused confessed to their fraudulent activities. The company immediately terminated the employment of all the accused individuals and an FIR has been filed against them.

Bajaj Allianz General Insurance has consistently demonstrated its commitment to operating fairly and transparently. By taking swift action against its employees, the company reaffirms its commitment to upholding the integrity of the insurance process. The company has stated that it will continue to adhere diligently to all necessary measures and fully abide by the directives of the court of law. With a zero-tolerance policy towards any form of insurance fraud, the company will continue to investigate and actively prosecute any fraudulent activities. The company encourages everyone to be vigilant and understand the consequences of insurance fraud and its impact on the industry and society.