Insurance as a Social Safeguard
Insurance is more than a financial mechanism—it is a social safeguard. It exists to protect individuals, families, and institutions at moments of vulnerability, and to sustain confidence in systems that support economic and social stability. As societies grow more complex, so do the risks they face, placing greater responsibility on the insurance ecosystem to respond with fairness, efficiency, and foresight.
An Industry in Transition
In recent years, the industry has been navigating a particularly challenging transition. Fraud has evolved from being episodic to systemic, often leveraging technology, scale, and coordination. This has raised fundamental questions around trust, sustainability, and the long-term credibility of insurance processes. Addressing these challenges is no longer the responsibility of isolated stakeholders—it requires collective vigilance, shared learning, and continuous improvement across the ecosystem.
Encouragingly, the industry has begun responding with intent. There is a visible shift toward data-led decision-making, technology-enabled investigations, stronger governance frameworks, and renewed focus on skill development. At the same time, there is a growing recognition that technology alone cannot deliver outcomes unless it is supported by ethical practices, trained professionals, and clear standards.
It is within this broader industry context that the reflections that follow are shared—not as prescriptions, but as experiences and observations from within the ecosystem. They represent one part of a larger, ongoing effort to strengthen insurance as a pillar of societal trust and economic resilience.
A Journey Aligned with Industry Realities
When we started Checkers and Trekkers Consultancies Services Private Limited, the vision was simple yet demanding—to contribute meaningfully to the insurance ecosystem with integrity, insight, and action. What began as a focused initiative has, over the last three years, evolved into a purpose-driven journey shaped by learning, responsibility, and trust.
As I reflect on our growth, what stands out most is how closely our evolution mirrors the changing realities of the insurance industry itself. Fraud today is no longer sporadic or incidental—it is systemic, adaptive, and increasingly sophisticated. The data reinforces this reality. Between 2022 and 2025, we investigated over 20 thousand insurance claims, examined claims worth more than ₹2,25 crore, and recommended savings exceeding ₹1,09 crore, delivering an average 48% savings for insurers.
These figures are not merely performance metrics—they represent the scale, complexity, and urgency of challenges insurers face every day.
From Reactive Investigation to Proactive Intelligence
This understanding has driven a shift toward technology-led investigation frameworks. Through IT system integration powered by Artificial Intelligence, Machine Learning, data analytics, and automation, investigation has moved from reactive responses to proactive intelligence—identifying behavioral patterns, predicting risks, and supporting faster, more defensible decision-making. In 2025 alone, this approach generated an estimated ₹39.19 return for every ₹1 invested by the insurers to our organisation.
Virtual Investigations and Digital Compliance
Equally significant has been the focus on virtual investigation models. In 2025, an internal video meeting tool aligned with the IRDAI’s Video Based Identification Process (VBIP)—as per IRDAI Circular No. IRDAI/SDD/CIR/MISC/245/09/2020 dated 18 September 2020—was introduced and named V-MEET.
In less than six months, more than 3,100 claims were investigated through structured virtual mechanisms, covering claim values exceeding ₹42 crore. These models have demonstrated that speed, scalability, and investigative rigour can coexist in a digitally connected insurance environment where timelines and accuracy are critical.
Strengthening Provider Governance
Alongside claims investigation, focused efforts have been initiated toward Service Provider Network Audits. In the last six months, more than 100 hospital audits have been completed, with the initiative continuing. Additional projects, such as non-network hospital audits for “cashless everywhere” cases (post-facto), have also been undertaken and have delivered significant outcomes.
Parallel to this, structured investigative databases continue to be built and maintained to enable industry alerts—supporting early detection of emerging fraud trends, reducing repeat exposure, and strengthening collective vigilance across the insurance ecosystem.
People, Ethics, and Capability Building
Yet, no system—no matter how advanced—can replace the value of ethical, disciplined, and well-trained professionals.
The field force remains the backbone of the insurance process—the first line of defence where observation, judgment, and accountability intersect. Equally vital is the medical fraternity, whose understanding of both clinical realities and insurance processes directly impacts claim integrity. Recognising this, training, education, and governance form the foundation of the operating philosophy.
To date, over 60 master training programs have been conducted, reaching more than 600 professionals across the insurance value chain, including:
- 464 field officers trained, with 196 currently active
- Over 110 medical auditors trained, including 36 doctors actively engaged
- 36 professionals trained across back-office, IT, MIS, data analytics, and automation functions
Training, however, must be supported by clear systems and ethical guardrails. To strengthen work ethics, consistency, and accountability across operations, 18 internal Standard Operating Procedures (SOPs) have been designed and implemented. These SOPs define investigative conduct, reporting standards, data handling, confidentiality, and quality benchmarks—ensuring uniformity and professionalism across every assignment.
In addition, four comprehensive HR policies have been developed to reinforce ethical behaviour, role clarity, performance discipline, and organisational responsibility—creating a culture where integrity is institutionalised, not assumed.
Together, these frameworks ensure that technology, talent, and ethics function in alignment, delivering outcomes that are not only efficient, but also transparent, fair, and defensible.
A Platform for Shared Perspective
Through DRISTIKON, the intent is to share experiences, insights, and data-backed perspectives—not as final answers, but as informed viewpoints that encourage reflection, dialogue, and better decision-making across the insurance ecosystem.
Because meaningful progress in insurance does not begin with information alone—it begins with the right perspective.
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