It is important to note that the role of an insurance claims department is to settle all valid claims. Fraud is real in all sectors of the financial service hence insurers have to verify all claims coming up for payment. This is how to verify

Proposal form

• In addition to the applicants’ health declaration, the proposal form obtains information of the applicant (life assured) about all other cover and/or benefits already in force or which are being applied for on concurrent proposals in the market.
• Basic information obtained at underwriting that would assist claims handling include:
• Details of occupation for Own Occupation disability applications and/or Income Protection I Replacement benefits;
• Medical history and treatment by the Family Practitioner in the case of an early claim

Individual business

• Check whether policy document and premiums have been received.
• Validate signatures, policy holder/owner and life assured details.
• Verify that the insurable interest is still the same as it was at underwriting stage? If not, why not?

Group business

• Check membership of the fund and premiums received.
• Check whether the member was over the Free cover limit (FCL) and underwritten for the excess cover.