Strengthening Insurance Integrity: Regulatory Challenges, And Fraud Prevention In A Global Context
- IJLLR Journal
- Jan 29
- 2 min read
Arushi Dixit, National Forensic Sciences University
Introduction
Parties entering into a contract have a fundamental obligation to act in good faith towards each other, demonstrating fairness and honesty in their dealings. However, there's no explicit, predefined duty to act in a certain way. Insurance contracts, though legally binding agreements, are unique. They hinge on the principle of Utmost Good Faith, or “uberrimae fidei”. This means both the insurer and the insured must act with complete honesty. The insurer, in particular, accepts the responsibility of covering the insured's future losses.
The foundation of an insurance contract rests upon the insured's detailed account of the facts. This is the primary method for the insurer to assess and understand the potential risks involved, risks that the insured agrees to manage. The insurer, lacking firsthand knowledge of the insured's specific circumstances and the associated risks, relies heavily on this information. Consequently, the insured's commitment to truthfulness and transparency is paramount.
In insurance contracts, the duty of good faith is elevated above that of general contract law. Because the insurer is vulnerable to the insured's information, the insured must act with "utmost good faith." This means not only truthfully representing the present situation but also proactively disclosing any future events or changes that could influence the risk profile. Examples include informing the insurer of a new business venture that may increase liability or a change in health conditions that could impact life insurance. This ongoing disclosure ensures both parties operate with transparency throughout the policy's duration, allowing the insurer to manage risk effectively and the insured to maintain coverage.
Furthermore, as the law now exists, the obligation to disclose and act in good faith is ongoing and does not end when a policy is formed.
The Insurance Act of 1938, mirroring other colonial-era legislation, largely adopted British legal frameworks. A critical omission was the explicit definition of "insurance fraud." This oversight, coupled with the absence of specific deterrent measures like penalties and investigative powers, left a significant gap in protecting policyholders and the insurance industry.
