Noble Insurance Company has received two claims about which the company has grave suspicions about their genuineness and admissibility under the terms of the insurance policy. To help them in the aspect of the genuinenes
CS Professional · Forensic Audit · PYQS · December 2020
Noble Insurance Company has received two claims about which the company has grave suspicions about their genuineness and admissibility under the terms of the insurance policy. To help them in the aspect of the genuineness of the two claims, it appoints a forensic auditor (FA). The claim is not payable where there has been negligence on the part of the insured. The FA was to also look into this aspect and report to the insurer. Bank cyber crime The first claim has been reported by a bank about the fraud committed in the account of one of its customers. The customer had a bank account in Chennai branch. According to the bank, the customer, a resident of India, was then living in New York. He used to periodically transfer amounts to some foreign accounts, i.e. accounts of other persons, who were outside India. He would send intimation through his email (Gmail account) and sign in the necessary forms, as may be required. The customer's Gmail account was hacked by a miscreant. The said miscreant sent an email from the customer's Gmail id (which was the official email id given to the bank), asking for transfer of funds to a bank account in Hong Kong. Since the bank had done such transfers in the past, it did the same during the said time also. A sum of ₹12 lakhs was transferred. Later on, when the customer saw his bank account, he found to his dismay that his account was debited with ₹12 lakhs. He alerted the bank and when enquiry was conducted, it turned out that his Gmail id had been hacked and that a fraudster had done the said fraud. The bank had to pay this amount since the customer was a valuable customer. As the bank had taken policy with the insurance company covering such losses, it lodged the claim and hence the present situation. How can the FA help the insurer in the given situation?
Answer & Explanation:
The Forensic Auditor first looked into the procedures required at the bank for transfer of funds to an account abroad. The main aspects involved were: Written request was to be received from the customer, if not so, through a digitally signed document. For any transfer of funds abroad, FEMA requirements are to be completed, including submission of Form 15CB under the Income-tax Act, 1961. Either a self-declaration of the customer was sufficient or a Chartered Accountant's certificate is required. Funds have to be transferred through electronic mode like SWIFT. When the Forensic Auditor tracked the funds which had been sent to an account in Hong Kong, it was found that the fraudster had closed the account and the Hong Kong bank disowned any liability, since it was not at fault. In the given case, the Forensic Auditor would have found the following: The banker had not received any written request from the customer for transfer of funds abroad. The Forms required under the Income-tax law had not been submitted. The compliances required under the Foreign Exchange Management Act 'FEMA' had not been complied with. The bank did not ascertain the identity of the customer. Therefore, it is clear from the facts of the case that the banker was negligent in his duties. The insurance policy excludes payability of the insurance claim, where the loss is caused due to the negligence of the insured. The Forensic Auditor was thus able to help Noble Insurance Company which repudiated the claim, as a consequence.
Topics: Forensic Audit in Cyber Crime
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