A vigilant claims processing team at Shriram General Insurance Company (SGIC), utilizing modern tools for investigation including AI, has assisted the UP Police in uncovering a significant motor claims fraud in Bareilly district. Additionally, the investigation officer has lodged an FIR against the culprit, and now examining whether the road accident case was actually a genuine one or a fraud for financial gain.
The case began with a road accident death claim against SGIC for Rs 12 lakh in 2018. On August 26, 2018, an FIR was registered for a road accident involving motorcycle riders Mr. Bhupendra and his friend Mr. Satyaveer. They were returning from a relative's place around 9:30 PM when their motorbike was hit by an unknown speeding vehicle from behind on Tanda Shahbad Road near Rampura Bhatta and Chaudhary Dhaba.
The impact severely injured both men. While the rider was declared dead on arrival at Shahbad Government Hospital, the pillion rider succumbed to his injuries on the way to Rampur Hospital. The family of the rider lodged an FIR under IPC 597/2018 section 279/338/304 – A, against the unknown vehicle, requesting the police to act and apprehend the vehicle and its driver. During the police investigation, two eyewitnesses, Prempal and Paan Singh, voluntarily came forward and identified the offending vehicle as bearing registration number UP 25 AT 0139.
Based on the eyewitness statements, the police filed a charge sheet against the vehicle owned by Mr. Aarif Khan of Paraskheda in CB Ganj, District Bareilly, and driven by Ali Miyan of Kakraua. The unknown vehicle was identified as a pick-up vehicle registered with SGIC for vehicle insurance. The family of the deceased submitted a motor insurance claim with SGIC for settlement. However, after examining the claim documents, including the FIR and charge sheet, the SGIC team questioned why the eyewitnesses did not provide their statements to the police on the night of the incident.
The SGIC team found this suspicious and requested the support of SIT (Special Investigation Teams) for further investigations. Upon investigation, the SIT discovered that the vehicle with registration number UP 25 AT 0139 was actually not involved in the accident but had been deliberately planted by the claimant with the collusion of Insured and driver as part of a scheme to fraudulently obtain a claim settlement from SGIC. The investigation also revealed that the same vehicle has been used for filing several similar claims with other general insurance companies in Bareilly District, proving the entire claim in this case was fraudulent. Based on the investigations, the claim was dismissed.
After completing the investigation, a case was registered by SIT officers at the Civil Lines police station in Rampur district under sections 193/420/120B of the Indian Penal Code (IPC) against Smt. Lajjawati (w/o Late Bhupendra), Smt. Asha (w/o Late Satyaveer), Shreepal, Prem Pal, Paan Singh, Arif, and Ali Miyan. The SIT has lodged an FIR against the alleged perpetrators and is confident of apprehending the criminals involved in this fraud.
The Supreme Court, after receiving numerous petitions regarding alleged fraudulent claims, advised the establishment of Special Investigation Teams (SIT) in all Indian states. Following this directive, among other states, the government of Uttar Pradesh formed SITs in 2015.
“SGIC is taking all possible measures to prevent such incidents from recurring. We are also working to raise awareness among the public, especially vulnerable groups who are more likely to be targeted by fraudsters. Fraudulent claims lead to higher premiums and erode trust within the system. By bringing this issue to light, we aim to benefit other insurers and our policyholders” says SGIC spokesperson.
Tools and Manpower Deployment
SGIC has deployed advanced AI tools and a dedicated team of investigators to tackle fraudulent claims. These tools help in analyzing patterns and identifying suspicious activities, while the team works closely with law enforcement agencies to ensure thorough investigations.
SGIC plans to initiate an awareness drive for policyholders and other stakeholders with the help of the SIT teams.