Fake Motor Accident Claims Using Fabricated Medical Records: Madras High Court Orders Enquiry Into 84 Withdrawn Claims

Justice N. Anand Venkatesh observed,

"This is not merely coincidental and it is more a knee-jerk reaction after complaints were made to the effect that claims have been filed with false and fabricated medical and hospital records of Cavery Hospital, Hosur. It is not clear as to whether the concerned Judges before dismissing the 84 claims as not pressed, even conducted any preliminary enquiry to ascertain as to why so many claims are not pressed."

The Court thus suo motu impleaded Secretary, Tamil Nadu State Legal Services Authority to enquire into the 84 claims, previously pending before ADJ, Hosur and PSJ, Hosur.

The High Court wants to ascertain whether the claims have been not pressed with the knowledge of the concerned claimants.

"The Secretary, Tamil Nadu State Legal Services Authority is directed to co-ordinate with the District Legal Services Authority and the claimants who have made the claims in the 84 MCOPs shall be summoned and enquiry shall be conducted to find out if the claims were not pressed after getting their concurrence. While conducting the enquiry, the Legal Services Authority shall also identify genuine claims and report it to the concerned insurance companies…", the court noted in the list of directions included in the order.

The court has also asked Cholamandalam MS General Insurance Company Limited to deposit a sum of Rupees two lakhs towards the expenses that State Legal Services Authority might incur by summoning the claimants concerned for enquiry. The Secretary has also been instructed to file a report before the court by the next date of hearing.

Exercising the powers under Article 226 and Article 227, the court has directed the restoration of the 84 cases on file by the Additional District Judges and Principal District Judge at Hosur.

"…In all the 84 cases, the State Legal Services Authority in co-ordination with the District Legal Services Authority shall appoint Panel Advocates to represent the claimants. This will ensure that in all those cases where the parties are able to arrive at a settlement and just compensation is fixed, an award can be passed by recording the compromise. In all those cases where there is a contest, the claimants will be ably assisted by the Panel Advocates to safeguard their rights and interests. If ultimately, it is found that fabricated/false records were filed before the Court, it will enable the Court to initiate action in the concerned MCOP cases", the court added.

The 84 claims currently under the radar of the court were dismissed as not pressed in 2019.

The status report filed by Assistant Inspector General of Police, Law and Order, Chennai sought more time for the completion of the probe which was accepted by the court. The police has been asked to thoroughly continue the enquiry and submit a report before the court by the next date of hearing, i.e., 4th April.

In the status report, it has been mentioned by the police that there is a 'concerted conspiracy' from the moment an accident takes place, and the 'modus operandi' of the teams comprising of brokers and specialised practitioners are 'skilled' and 'well entrenched' to create serious ramifications for all concerned stakeholders.

"There are several instances of even 108 Ambulances being driven to a private hospital, very nearly hijacked, one can say, after recording Accident Register copy in a government hospital, for the record. This has a critical and detrimental impact on trauma care, during the "Golden Hour" in the treatment to victim", the additional affidavit filed by the respondent police states.

After acknowledging the status report, the court has also asked the special investigation team to enquire the concerned officials of Tamil Nadu Accident and Emergency Care Initiative (TAEI) that has trauma care centers on Highways and record their statements in the report that will be submitted before the court.

Background

In the beginning of 2021, Cholamandalam MS General Insurance Company Limited had filed a petition before the High Court seeking directions for the constitution of a Special Investigation Team to investigate nearly 120 claims made through fake and fabricated insurance policies.

The petitioner Company contended that fake claims have been made on the basis of fake insurance policies by tampering with insurance policies, taking advantage of the online mode of filing documents and completing transactions. The company submitted that they had come across 120 claims so made on the basis of fake insurance policies running to the tune of 15.63 crores.

Noting the wide ramificiations of fake claims and the concerted efforts of those behind the fake policy scam, Madras High Court ordered the constitution of SIT in March, 2021. Pursuant to the court order, an interim SIT with Assistant Inspector General of Police at its helm was formed.

It is pertinent to note here that a digital platform to upload the documents pertaining to motor accident claims and a Detailed Accident Report (DAR) Regime came into force after the High Court passed directions to that effect in another similar case in 2016. In 2020, after the receipt of a report submitted by the expert committee headed by Retd. Justice K. Chandru, the court found out that there were nearly 280 false claims equivalent to Rs 50 crores which was withdrawn.

In 2020, in yet another case, the court went on to pass a few directions for effective implementation of DAR regime.

Case Title: Cholamandalam MS General Insurance Company v. Director General of Police & Ors

Case No: Crl.O.P.Nos.2302 and 4174 of 2021 and Crl.M.P.No.13952 of 2021

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