This document outlines the services provided by ACE solution for insurance claims investigation. It discusses common types of fraud in insurance claims and outlines ACE solution's process for investigating claims. Key services include investigating fraud by doctors, hospitals, or insured individuals. Fees are listed for different types of individual and corporate insurance claim investigations. Contact information and the leadership team of ACE solution is also provided.

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*General Insurance –
Individual / Corporate Medi-claim Policy.
Personal Accident Policy, Critical illness Policy,
other Health Insurance Policy.
Copyright 2010 © Ace solution Nagpur.

2. Frauds by Treating DoctorFrauds by Treating Doctor
Frauds by InsuredFrauds by InsuredFrauds at Hospital / Diagnostic levelFrauds at Hospital / Diagnostic level
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3. 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 documents
f) Duplicate / Fraudulent Medicine Bills From
Medical Store
g) Over stay and inflated bills of hospital.
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4.  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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5.  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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6.  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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7.  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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8.  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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9.  MIRZAPUR , ALLAHABAD ,
 VARANASI , KANPUR ,
 LUCKNOW , JHANSI ,
 KANPUR DEHAT , FATEHPUR ,
 PATNA , HAZIPUR ,
 BIHARSARIFF.
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10. Any Location
Corporate 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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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.)

11.  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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12. 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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13. 10 cases per month Individual .
20 cases per month Corporate.
* FEES quota-Ted we will decide on no. of
cases.
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14.  General Manager – Dr. Y.M.Bhargava
Qualification : 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-LLB
3) one- B.com.
2 peons : 10th
passed.
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15.  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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16.  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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…..you look bravely!