--- title: Curated Insight: India's new Insurance fraud framework description: Discover India's new guidelines for combating insurance fraud, focusing on zero-tolerance, fraud management committees, and comprehensive fraud monitoring. image: https://riskinsights.com.au/hubfs/Canva%20images/Canva%20Design%20DAG47AguX0E.png --- [Skip to content](https://riskinsights.com.au/blog/curated-insight-indias-new-insurance-fraud-framework#main-content) [![Risk Insights - Logo - (RGB, Horizontal, Small)](https://riskinsights.com.au/hs-fs/hubfs/Risk%20Insights%20-%20Logo%20-%20(RGB%2c%20Horizontal%2c%20Small).png?width=200&height=40&name=Risk%20Insights%20-%20Logo%20-%20(RGB%2c%20Horizontal%2c%20Small).png)](https://riskinsights.com.au) - [Articles](https://riskinsights.com.au/blog) - [Approach](https://riskinsights.com.au/approach) Show submenu for Approach - [Commissions (Accuracy)](https://riskinsights.com.au/broker-partner-commission-accuracy-reviews) - [Claims Fraud (Fairness)](https://riskinsights.com.au/claims-fraud-fairness-reviews) - [Fees and Charges (Accuracy)](https://riskinsights.com.au/fee-and-charge-accuracy-reviews-risk-insights) - [About](https://riskinsights.com.au/about) - [Contact](https://riskinsights.com.au/contact) Open main navigation Close main navigation - [Articles](https://riskinsights.com.au/blog) - [Approach](https://riskinsights.com.au/approach) Show submenu for Approach - [Commissions (Accuracy)](https://riskinsights.com.au/broker-partner-commission-accuracy-reviews) - [Claims Fraud (Fairness)](https://riskinsights.com.au/claims-fraud-fairness-reviews) - [Fees and Charges (Accuracy)](https://riskinsights.com.au/fee-and-charge-accuracy-reviews-risk-insights) - [About](https://riskinsights.com.au/about) - [Contact](https://riskinsights.com.au/contact) --- 06 Nov 2025 # Curated Insight: India's new Insurance fraud framework ![Picture of Yusuf Moolla](https://riskinsights.com.au/hs-fs/hubfs/Yusuf_Moolla_Headshot-transformed.png?width=50&name=Yusuf_Moolla_Headshot-transformed.png) [Yusuf Moolla](https://riskinsights.com.au/blog/author/yusuf) Share: [linkedin-in icon](http://www.linkedin.com/shareArticle?mini=true&url=https://riskinsights.com.au/blog/curated-insight-indias-new-insurance-fraud-framework) [envelope icon](mailto:?body=https://riskinsights.com.au/blog/curated-insight-indias-new-insurance-fraud-framework) **TL;DR** • This resource is from the Insurance Regulatory and Development Authority of India (IRDAI). • The IRDAI's new Insurance Fraud Monitoring Framework Guidelines. • It asks insurers to target zero-tolerance for fraud, with risk management including a board approved policy, monitoring committee, and monitoring unit.   This featured resource is IRDAI's new [Insurance Fraud Monitoring Framework Guidelines 2025](https://irdai.gov.in/documents/37343/366029/%E0%A4%86%E0%A4%88%E0%A4%86%E0%A4%B0+%E0%A4%A1%E0%A5%80%E0%A4%8F%E0%A4%86%E0%A4%88+%28%E0%A4%AC%E0%A5%80%E0%A4%AE%E0%A4%BE+%E0%A4%A7%E0%A5%8B%E0%A4%96%E0%A4%BE%E0%A4%A7%E0%A4%A1%E0%A4%BC%E0%A5%80+%E0%A4%A8%E0%A4%BF%E0%A4%97%E0%A4%B0%E0%A4%BE%E0%A4%A8%E0%A5%80+%E0%A4%A2%E0%A4%BE%E0%A4%82%E0%A4%9A%E0%A4%BE%29+%E0%A4%A6%E0%A4%BF%E0%A4%B6%E0%A4%BE%E0%A4%A8%E0%A4%BF%E0%A4%B0%E0%A5%8D%E0%A4%A6%E0%A5%87%E0%A4%B6%2C+2025+_+IRDAI+%28Insurance+Fraud+Monitoring+Framework%29+Guidelines%2C+2025.pdf/99fa5c70-aee2-43af-d52b-50818f53c1df?version=1.1&t=1760095258963&download=true). It establishes stricter fraud prevention requirements for India's insurance industry from April 2026. The guidelines will be of interest to insurers operating in or considering the Indian market. They're also useful more broadly, explaining what an anti-fraud policy must contain, and calling for a dedicated fraud monitoring committee. Here are some key takeaways: ## Five Fraud Categories (Insurers must address) - **Internal Fraud**: involving employees or senior management - **Distribution Channel Fraud**: involving intermediaries or distribution partners - **Policyholder and Claims Fraud**: committed by any person during purchase, servicing, or claiming of insurance policies to obtain undue coverage or payment - **External and Cyber Fraud**: perpetrated by external parties or third parties - **Affinity or Complex Fraud**: schemes involving multiple parties / collusion ## Three Core Requirements (each relevant to algorithm integrity) - **Board-Approved Anti-Fraud Policy**.  For algorithm integrity, this: explains red flag indicators and fraud detection procedures, and sets expectations that algorithmic processes must adhere to. - **Fraud Monitoring Committee (FMC)**. For algorithm integrity, this can provide ongoing oversight of algorithmic performance and bias. For example, the FMC will conduct annual risk assessments; these then guide algorithm development or adjustments. - **Fraud Monitoring Unit (FMU)**. For algorithm integrity, this can include detailed analysis of algorithm effectiveness and false positive rates. For example, the FMU enables human oversight, regular review, and independent validation. If done properly, these establish important safeguards addressing transparency, accountability, and fairness in algorithmic fraud detection and triage.   The full guidelines are available [here](https://irdai.gov.in/documents/37343/366029/%E0%A4%86%E0%A4%88%E0%A4%86%E0%A4%B0+%E0%A4%A1%E0%A5%80%E0%A4%8F%E0%A4%86%E0%A4%88+%28%E0%A4%AC%E0%A5%80%E0%A4%AE%E0%A4%BE+%E0%A4%A7%E0%A5%8B%E0%A4%96%E0%A4%BE%E0%A4%A7%E0%A4%A1%E0%A4%BC%E0%A5%80+%E0%A4%A8%E0%A4%BF%E0%A4%97%E0%A4%B0%E0%A4%BE%E0%A4%A8%E0%A5%80+%E0%A4%A2%E0%A4%BE%E0%A4%82%E0%A4%9A%E0%A4%BE%29+%E0%A4%A6%E0%A4%BF%E0%A4%B6%E0%A4%BE%E0%A4%A8%E0%A4%BF%E0%A4%B0%E0%A5%8D%E0%A4%A6%E0%A5%87%E0%A4%B6%2C+2025+_+IRDAI+%28Insurance+Fraud+Monitoring+Framework%29+Guidelines%2C+2025.pdf/99fa5c70-aee2-43af-d52b-50818f53c1df?version=1.1&t=1760095258963&download=true) (or search the [IRDAI website](https://irdai.gov.in/)).   --- Disclaimer: The information in this article does not constitute legal advice. It may not be relevant to your circumstances. It was written for specific algorithmic contexts within banks and insurance companies, may not apply to other contexts, and may not be relevant to other types of organisations. ---   ![Weekly Articles                                                                                             Get weekly emails in your inbox.  ](https://hubspot-no-cache-ap1-prod.s3.amazonaws.com/cta/default/44032070/interactive-182785203045.png) ## Related posts [!["Profile of a fraudster": a misnomer?](https://riskinsights.com.au/hs-fs/hubfs/Profile%20of%20a%20fraudster%20a%20misnomer.png?height=200&name=Profile%20of%20a%20fraudster%20a%20misnomer.png)](https://riskinsights.com.au/blog/profile-of-a-fraudster-a-misnomer) ## ["Profile of a fraudster": a misnomer?](https://riskinsights.com.au/blog/profile-of-a-fraudster-a-misnomer) 11 Jun 2026 TL;DR • The ACFE's "Report to the Nations" is a widely cited occupational fraud study, and is a... 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[Read more](https://riskinsights.com.au/blog/curated-insight-fraud-detection-in-the-eu-ai-act-based-on-recent-draft-guidance) We acknowledge Aboriginal and Torres Strait Islander peoples as the Traditional Custodians of the lands on which we live and work. We pay our respects to Elders past and present, and honour the rich diversity of the world's oldest living cultures. [View our LinkedIn page](https://www.linkedin.com/company/riskinsightsap) [email us](mailto:info@riskinsights.com.au) [Call us](tel:+61408946143) 2026 Risk Insights Pty. 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