How to Protect Yourself From Insurance Fraud in India — Red Flags, Real Scams, and IRDAI Rights

By Rahul NarangUpdated:
How to Protect Yourself From Insurance Fraud in India

The Indian insurance industry loses approximately ₹3 trillion annually to various forms of fraud. This figure sounds abstract until you understand the consequences for genuine policyholders: higher premiums (because fraudulent claims increase insurer costs), claim delays (because insurers apply additional scrutiny to every claim), and sometimes direct financial loss when fraud is perpetrated against them personally.

Insurance fraud in India operates at multiple levels — from hospitals inflating bills to phishing calls impersonating IRDAI officials to completely fake policies sold by unlicensed agents. In Noida's densely connected residential communities, where referral-based selling is common, fraud spreads quickly when even one trusted person introduces a fraudulent product.

This guide covers the most common fraud types in 2025, the red flags that identify them, and what to do if you suspect you've been targeted.


Type 1 — Fake Insurance Policies

This is the most damaging fraud for individual policyholders. An unlicensed agent or a fraudster impersonating a legitimate agent sells a policy that appears real — complete with documents, a policy number, and a premium payment receipt. The policyholder believes they're covered. They're not.

A real case that happened in NCR: In 2024, a network operating in Delhi-NCR issued fake "cashless health insurance" cards under the name of a well-known insurer. Hundreds of families paid premiums. When they presented the cards at hospitals, the hospitals found no record of the insurer's authorization for cashless treatment. The policies were entirely fabricated.

How fake policies are recognized:

  • The agent pressures you to decide quickly and doesn't allow time to verify
  • The agent refuses to share their IRDAI license number or ID
  • Payment is requested in cash or via UPI to a personal account (not the insurer's official account)
  • Policy documents have spelling errors, unusual formatting, or an insurer name that's slightly different from the legitimate one
  • The premium is dramatically lower than anything available elsewhere for similar coverage

How to verify any insurance purchase:

Always verify that the insurer is IRDAI-registered: visit www.irdai.gov.in and check the registered insurer list. Verify the policy number directly with the insurer by calling their official helpline (found on their official website — not a number given to you by the agent). If buying through an agent, verify their IRDAI license by requesting their license number and checking it on the IRDAI website.


Type 2 — Spurious Calls Claiming to Be IRDAI or the Insurer

IRDAI regularly warns the public about this. The organization explicitly states: IRDAI does not call individuals to sell insurance, offer bonuses, or request personal financial details. An IRDAI official will never call you about your policy.

The fraud pattern:

A caller identifies themselves as being from IRDAI or from your insurance company. They say your policy is due for upgrade, that you have an unclaimed bonus, or that your policy is at risk of cancellation. They request personal information — your policy number, Aadhaar, PAN, bank account details, or OTP.

Once they have this information, they either use it to make changes to your policy without your consent, access your financial accounts, or sell it to other fraudsters.

Red flags:

  • Unsolicited calls about your insurance from people you didn't contact
  • Claims about bonuses or "unclaimed benefits" not reflected in your insurer's official communications
  • Requests for OTP, PIN, or bank details over the phone
  • Urgency ("you must respond in 24 hours or your policy will be cancelled")

What to do:

Hang up. Don't provide any information. Call your insurer directly using the number on their official website or your policy document. Report the number to IRDAI's integrated grievance management system at igms.irda.gov.in or call 155255.


Type 3 — Claim Fraud Against Your Policy

This type of fraud is perpetrated against policyholders by others using their policy information. If someone obtains your policy number and personal details, they may attempt to file fraudulent claims against your health insurance.

Consequences for you: Your claim history is affected. Your No Claim Bonus may be lost. Your renewals may face increased scrutiny or premium loading.

How to protect:

  • Never share your health card, policy number, or personal details with anyone you don't know and trust
  • Monitor your claim history through your insurer's app or policyholder portal
  • If you receive a claim settlement SMS for a treatment you didn't receive, contact your insurer immediately

Type 4 — Hospital Billing Fraud in Health Claims

This is fraud perpetrated against the insurer using your identity — but it affects you indirectly through higher premiums and claim scrutiny.

Some hospitals inflate bills for insurance claims — adding procedures that weren't done, billing at higher rates than actually charged, or claiming for longer stays than occurred. The insurer pays, claims costs rise industry-wide, and premiums increase for everyone.

Your role in preventing this:

Before signing the discharge summary and hospital bill, review the charges. If something doesn't match what was actually done during your treatment, question it. Signed documents that contain false information can create complications in claim investigation.


Type 5 — Policy Mis-Selling

This is fraud that's harder to recognize because the perpetrator is often your own insurance agent or a broker representative. Mis-selling includes:

  • Presenting the wrong product for your needs (selling a ULIP to someone who only needs term insurance)
  • Making false claims about policy benefits (promising returns that the product doesn't actually generate)
  • Concealing important exclusions or waiting periods
  • Churning policies — persuading you to cancel a good policy and buy a new one unnecessarily (the agent earns a new first-year commission; you restart waiting periods)

Protection:

Read the policy document during the free-look period (30 days from receiving the policy). If what you received doesn't match what you were promised, you can return the policy within this period for a full refund of premium minus administrative charges.

If you believe a policy was mis-sold, file a complaint with IRDAI at igms.irda.gov.in. IRDAI's 2025 Insurance Fraud Monitoring Framework (effective April 2026) now requires insurers to actively pursue mis-selling cases — this regulatory support gives genuine complaints more institutional backing.


How to Report Insurance Fraud

Step 1: Contact your insurer's fraud/grievance cell directly. Provide all documentation.

Step 2: File a formal complaint with IRDAI through the Integrated Grievance Management System (IGMS) at igms.irda.gov.in. You can also call IRDAI's toll-free number: 155255 or 1800-4254-732.

Step 3: For serious fraud involving fake agents or criminal intent, file a police complaint at your nearest police station. Digital fraud can also be reported at cybercrime.gov.in.

Step 4: If the fraud involves a significant financial loss and the insurer or IRDAI doesn't resolve the complaint satisfactorily, approach the Insurance Ombudsman for your region. The ombudsman provides free, binding dispute resolution.


Why IRDAI-Licensed Brokers Like Policywings Matter

One structural protection against fraud is buying insurance through IRDAI-licensed intermediaries who have regulatory accountability. Policywings is licensed under IRDAI license DB 835. Our business depends on our regulatory standing and our reputation — motivations that don't apply to unlicensed agents operating outside the regulatory framework.

When you buy through a licensed broker, you have a formal grievance channel if something goes wrong. When you buy from an unlicensed agent who disappears after collecting your premium, you have very few practical options.

Verify any intermediary's license before purchasing through them: ask for their IRDAI license number and verify it at policyholder.gov.in.

To buy genuine insurance from verified sources, or to verify whether a policy you were sold is legitimate, call +91-98111-67809.


Policywings Insurance Broking Pvt. Ltd. | IRDAI License No. DB 835 | A-57, 5th Floor, Sector-136, Noida | +91-98111-67809

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