04/15/23ACE solution, Insurance Claims And

Investigation(Division of ASPL) 1

*General Insurance –Individual / Corporate Medi-claim

Policy. Personal Accident Policy, Critical illness Policy,

other Health Insurance Policy.

Copyright 2010 © Ace solution Nagpur.

Frauds by Treating DoctorFrauds by Treating Doctor

Frauds by InsuredFrauds by Insured Frauds at Hospital / Diagnostic levelFrauds at Hospital / Diagnostic level

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Investigation(Division of ASPL) 2

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a) Concealing or non-disclosure of material fact – PED

b) Nexus between Insured and agent.c) Nexus between agent and treating doctor.d) Non-disclosure of exact onset of disease.e) Manipulation / Fabrication of documentsf) Duplicate / Fraudulent Medicine Bills From

Medical Storeg) Over stay and inflated bills of hospital.

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Investigation(Division of ASPL) 3

It will reduces Claim ratio Saving, money saved is earned. Directly and indirectly appropriate

service available to claimant ( in hospital) Unnecessary claim amount reduces

beneficial to company as well as to insured.

Increased credibility in market. Reformative action for better society.

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Investigation(Division of ASPL) 4

COST-EFFECTIVE Team of Doctors/Medicals professional

Having Domain Knowledge Of Process Of Claims And Investigations

Services Medical Expert’s opinion provided on critical / complicated cases.

Team of medico legal experts having domain knowledge of process of claims and investigations.

Single contact person/ medical professional in office for all queries.

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Investigation(Division of ASPL) 5

We can provide Medical Expert’s opinion with nominal charges in complicated cases.

In cases of PA claims and Death Claims, copies of MLC, Panchnama and FIR and even Post Mortem Reports with sketch or photograph of Accident site, movies of accident sites can be provided at nominal charges

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Investigation(Division of ASPL) 6

Akola Amravati Buldana Yavatmal Washim, Aurangabad Beed Hingoli Jalna Latur

Nanded Osmanabad Parbhani , Mumbai Mumbai Suburban District

Thane Raigad Ratnagiri Sindhudurg, Bhandara Chandrapur Gadchiroli Gondia

Nagpur Wardha , Ahmednagar Dhule Jalgaon Nandurbar

Nashik, Kolhapur Pune Sangli Satara Solapur.

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Investigation(Division of ASPL) 7

Chambal Division Morena Sheopur Bhind Gwalior Division Ashoknagar Shivpuri Datia

Guna Gwalior Indore Division Alirajpur Barwani Burhanpur Dhar

Indore Jhabua Khargone Jabalpur Division Balaghat Chhindwara Jabalpur

Katni Mandla Narsinghpur Seoni Narmadapuram Division Betul Harda

Hoshangabad Rewa Division Rewa Satna Sidhi Singrauli Sagar Division Chhatarpur Damoh Panna Sagar

Tikamgarh Shahdol Division Anuppur Shahdol Umaria Dindori Ujjain Division Agar Malwa Dewas Mandsaur

Neemuch Ratlam Shajapur Ujjain

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Investigation(Division of ASPL) 8

MIRZAPUR , ALLAHABAD ,

VARANASI , KANPUR ,

LUCKNOW , JHANSI ,

KANPUR DEHAT , FATEHPUR , PATNA , HAZIPUR , BIHARSARIFF.

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Investigation(Division of ASPL) 9

Any LocationCorporate individual on line cases- Rs. 1800/-

(only at listed city.)Corporate individual reimbursement Rs.3500/-

With all expenses no other charges or cost within our location.

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Investigation(Division of ASPL) 10

Any Location :

Individual reimbursement Medi-claim policy or any such health insurance policy - Rs.3500/- (including of all taxes ) within our location.

Critical illness - Rs. 3000/-

• Individual on line cases - Rs. 1800/- (only at listed city.)

Other than listed city Fees is same ; EXCLUDING EXPENSES OF LODGING, BOARDING,

TRAVELING AND FOOD OUT-SIDE listed LOCATION.

SUCH EXPENSES WILL BE BEARED BY COMPANY WHO ALLOTTED THE CASE.

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Investigation(Division of ASPL) 11

No Other out of pocket expenses like Conveyance charges, Xerox/Courier, Expert Opinion, Second City Visit charges and Miscellaneous charges to be extra at actual.

Except in case allotted out side the area specified.

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10 cases per month Individual .20 cases per month Corporate. * FEES quota-Ted we will decide on

no. of cases.

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Investigation(Division of ASPL) 13

General Manager – Dr. Y.M.BhargavaQualification : BHMS; BA(eng.lit.); LLB (Pune Univ.)

PGDF&RL Experience : 3yrs.

Asst. Manager : Mr. Anand Gandhi. Qualification : B.com. Experience : 8yrs. As MT. computer

application.

3 Executives : 1) one-B.Pharma.2) one-LLB3) one- B.com.

2 peons : 10th passed.

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Investigation(Division of ASPL) 14

  Dr. Sitaram Singh    Adv.Mukund Rajgude   Dr. Artee Gandhi    Anand Gandhi   Dr. Sanjay Pol    Mr.Sanjay Batunge.   Dr.Vijay Sutar    Pankaj M. Bhargava   Dr.Mantri    Rajesh Pariyani   Dr. Navneet Bhisekar    Praveen kumar   Dr. Prashant Kulkarni    Dharmendra Singh   Dr. Rajesh Sur    Anil Patil Dr. Mrs. Vandana Kullarni   Nikhil Kurmwnshi Dr.Pankaj Gandhi.    Vinay Suryavanshi Dnyaneshwar Aute   sam Dinkar Kshirsagar Hansdhwaj Ahirrao Ganesh Abhange Pathak Vijay Patil. Pankaj Munoth.

.

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Investigation(Division of ASPL) 15

Dig out PED in high value insurance claim case.

Bonus on repudiation of high value insurance claim cases.

Fees will be 1% on sum insured or claim amount or as per pre approval of insurance company only on repudiation of cases.

Other terms and condition in claim investigation as per insurance company who allotting cases or as in agreement.

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Investigation(Division of ASPL) 16

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…..you look bravely!