IRDAI Fraud Monitoring Framework Is Now in Force: What Insurers Need to Implement Next

As of April 1, 2026, the Insurance Regulatory and Development Authority of India Fraud Monitoring Framework is officially in force, introducing a structured approach to fraud prevention across the insurance sector.

The framework sets out what insurers and distribution channels must establish to deter, prevent, detect, report, and remedy fraud risks across their operations.

However, while the framework defines governance, processes, and responsibilities, it leaves open an important question:

How should these requirements be implemented in practice?

What the IRDAI framework requires

The guidelines establish a comprehensive fraud risk management system built around several key components:

• A board-approved anti-fraud policy, including Red Flag Indicators (RFIs), investigation processes, and defined responsibilities
• Oversight by the Risk Management Committee (RMC) and dedicated structures such as the Fraud Monitoring Committee (FMC) and Fraud Monitoring Unit (FMU)
• Ongoing fraud risk identification, mitigation, and monitoring across business activities
• Continuous review and updating of RFIs based on trends and past incidents
• Measures to address cyber and “new age” fraud through strengthened systems and controls
• Participation in the Insurance Information Bureau (IIB) framework for industry-wide fraud data sharing
• Structured reporting, including annual fraud reporting (FMR-1) and escalation to regulators and law enforcement

The framework also introduces a zero-tolerance approach to fraud and requires insurers to maintain incident databases, monitor distribution and vendor activity, and analyze customer complaints and patterns.

Types of fraud covered

The framework requires insurers to address multiple categories of fraud:

• Internal fraud (employees and management)
• Distribution channel fraud
• Policyholder and claims fraud
• External/vendor fraud
• Affinity or complex fraud involving collusion
• Cyber or “new age” fraud involving digital technologies

This highlights that fraud risk spans multiple actors, channels, and increasingly digital environments across the insurance lifecycle.

The implementation gap

While the framework defines governance and monitoring expectations, it does not prescribe the specific technical mechanisms insurers should use.

In practice, insurers still need to determine:

• How to build continuous fraud monitoring into digital insurance journeys
• How to strengthen detection of cyber and new age fraud in real-world scenarios
• How to enrich Red Flag Indicators with more dynamic and context-driven signals
• How to improve pattern recognition across interactions, entities, and channels

This creates a gap between regulatory requirements and operational execution.

How JuicyScore can help insurers operationalize IRDAI fraud monitoring requirements

JuicyScore provides a device intelligence risk scoring solution that can support insurers in implementing parts of the IRDAI framework without relying on PII (personally identifiable information).

1. Supporting Red Flag Indicators (RFIs)

The framework requires insurers to define and continuously update RFIs.

JuicyScore can help by:

• generating dynamic risk signals based on device and behavioral anomalies
• identifying suspicious patterns not visible through static rules
• supporting ongoing refinement of RFIs as fraud patterns evolve

2. Strengthening continuous monitoring

IRDAI requires ongoing monitoring of fraud risks across customer activity, distribution channels, and vendors.

JuicyScore supports this by:

• enabling continuous risk assessment during user interactions
• identifying anomalies across onboarding, policy servicing, and claims processes
• providing consistent visibility into risk signals across channels

3. Supporting cyber and “new age” fraud detection

The framework requires insurers to establish robust cybersecurity controls, continuously strengthen systems and processes, and use relevant technological expertise to manage cyber fraud risks.

JuicyScore can contribute by helping detect:

• device environment anomalies
• remote access tools
• emulators and virtual environments
• automated or scripted behavior

4. Enhancing fraud pattern recognition

The framework emphasizes maintaining fraud databases and identifying patterns across cases.

JuicyScore supports this by:

• enabling linkage of activity across interactions using device-level signals
• helping identify coordinated or repeated suspicious behavior
• supporting broader fraud pattern analysis

5. Supporting investigation and reporting processes

The framework requires structured fraud case tracking and reporting.

JuicyScore can support this by:

• providing additional technical context for fraud investigations
• enriching fraud cases with device and behavioral data
• helping improve classification and analysis of fraud events

From compliance to execution

The IRDAI framework sets the standard for fraud governance. The next step is building the technical infrastructure required to support continuous fraud monitoring and detection at scale.

For insurers, this means moving beyond static controls toward more adaptive, data-driven approaches to fraud risk management.

Next steps

• Download the PDF: official IRDAI requirements

• Download the PDF: IRDAI requirements mapped to fraud detection capabilities with JuicyScore

• Book a demo with the JuicyScore team — we’ll walk you through how this works in practice