Shriram General Insurance Wins Landmark Court Case Against Fraudulent Motor Insurance Claim.

Hyderabad, 22nd of March, 2025 :  In a landmark judgement which could lay the rules for motor claims settlement, the Madhya Pradesh High Court has asked the DGP of the State to set up a Special Investigation Team (SIT) to probe a malicious nexus between doctors, lawyers and police officials in motor claims cases. Shriram General Insurance Company (SGIC), part of the Shriram Group, won this landmark judgment it it’s favour from the High Court of Madhya Pradesh in a fraudulent Motor Insurance claim.

The case also exposed a nexus between a Hospital, Police Officials and Lawyers to claim motor vehicle accident insurance money by submitted forged documents, fraudulent certificates and medicine bills. The Hon’ble High Court taking cognisance of discrepancies in the claim documents submitted ruled that the claim was fraudulent and ruled in favour of Shriram General Insurance.

The Hon’ble Court in its Order (attached along with) has referred the matter to Principal Secretary, Public Health and Family Welfare and Medical Council of India to initiate appropriate action against Dr. Sharad Dwivedi and Dr. Balkrishna Dang false and forged medical certificates.

The Hon’ble High Court has also referred the matter to the State Bar Council for taking action against Adv. Shri Manoj Shivhare for obtaining a forged and fabricated medical certificate as well as directed the Director General of Police to form a high-level S.I.T to investigate cases of false implication involving the collusion of three parties: the claimant, police officials, and the doctors concerned.

The claimant, Rakesh Valtiya, had sought compensation for injuries sustained in a road accident involving a pickup vehicle. However, upon examination of the evidence, the court identified discrepancies, particularly with respect to a disability certificate provided by the Dr. Sharad Dwivedi, Member of the District Medical Board without actually examining the patient.

The discharge card was by Dr. Balkrishna Dang submitted was of Sudha Hospital and not Suvidha Hospital where he worked. The glaring discrepancy between date of admission and date of discharge in the discharge card vis-à-vis the same on the bill proved beyond doubt that the discharge card was a forged document.

The Claimant’s own testimony that he had never visited the hospital and that all the necessary certificates, etc were organised by the Counsel further proved that Dr. Sharad Dwivedi has never examined the Claimant and all certificates issued by him, in conjunction with Adv. Shri Manoj Shivhare, were fraudulent with the intent of defrauding the Insurance Company. The State Bar Council has been instructed to take appropriate action against the claimant’s counsel, Manoj Shivhare, for his role in obtaining the forged medical certificate.

The Court directed that the Director General of Police to constitute a high-level team in the form of S.I.T. to investigate the cases of false implication where three parties are necessarily in connivance namely claimant, police, officials of the region and the concerned Doctors. Besides this, sometimes claimants act at the behest on provocation of their counsel who are practicing in the field of motor accident claim cases or in the field of criminal law. Thus, S.I.T. be requested to examine these frauds with the system which are being perpetuated day in day out causing dent to the credibility of the judicial system.

Commenting on the decision of the court, Ashwani Dhanawat Executive Director, Shriram General Insurance Company said, “This outcome is a testament to our ongoing efforts to safeguard policyholders and ensure the long-term stability of the state’s insurance system. As stewards of both policyholder and shareholder funds, we bear the responsibility of ensuring these resources are allocated to legitimate claims. This reinforces our commitment to a robust claims management framework, which is focused on identifying and preventing fraud, while ensuring that our resources are directed towards those policyholders who genuinely require protection.”

He further emphasized, “The High Court’s ruling underscores the critical importance of maintaining the highest standards of professional ethics and strict adherence to medical guidelines in the assessment and certification of disabilities. This decision serves as an important reminder that both the legal and medical professions must work collaboratively to uphold the values of integrity, transparency, and public trust.”

Additionally, Dhanawat highlighted, “The compensation to motor accident victim is a beneficial act, designed to support genuine claimants. However, scamsters often try to exploit this by indulging in fraudulent activities. The Hon’ble court recognized this in the case and took cognizance of the same, reinforcing the importance of safeguarding the integrity of such beneficial Act.”

Compensation Adjustments and Deductions:

While the court upheld the fact of the accident and compensation for loss of income, it made significant deductions from the total compensation due to the fraudulent bills. A total amount of ₹52,053/- was deducted from the claimant’s awarded compensation. After considering the deductions, the final compensation payable to the claimant is ₹2,22,043/-. SGI had appealed against the order of the tribunal for compensation of ₹2,74,096/-.

About Shriram General Insurance Company:

Shriram General Insurance Company (SGIC), jointly owned by Shriram Group and Sanlam Ltd, Africa offers a complete range of general insurance products, ranging from motor, home and personal accidents in the retail space and customized products like fire, engineering, and marine Insurance in the corporate space. Shriram General Insurance manages assets worth Rs. 13003.88 Cr across with 64 lakh live policies. The company has 278 branches in 26 states and an employee strength of 4012 across India, as of 31 Dec, 2024.

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