Experts warn of sharp rise in health insurance frauds

Nine out of ten frauds in country's insurance sector occur in the mediclaim policy segment and there is a need to adopt measures to reduce the trust deficit between insured and insurer, experts have said.

"In insurance industry, number of grievances received or number of frauds committed is an indicator of growth trend of particular segment. In entire insurance sector, 90 per cent of frauds and grievances come from health policies," said Niraj Kumar, General Manager, Oriental Insurance Company.

He was addressing a seminar on health insurance at Amity University yesterday. Kumar said if one has to draw two curves for health insurance segment, one indicating growth and second learning curve, it can be observed that the growth curve is ahead of learning curve.

This, he added, implies that industry's main aim is only to sell and market health policies, but there are important takeaways in such shortcomings so that the level of mistrust between insured and insurer can be minimised.

Richard Kipp, Managing Director, consulting firm Milliman said, health insurance in India has increased tremendously] over few years but India needs to be cautious in its growth vis-à-vis the US where growth has now become stagnant.

Neeraj Basur, Chief Financial Officer, Max Bupa Insurance

Company said that there is lack of trust level among hospitals, third party administrators, insurance companies and customers.

The trust level has to improve and all stakeholders have to understand that it is the customer whose interest is the binding factor, he added.

R R Grover, Advisor, Amity School of Insurance, Banking &Nine out of ten frauds in country's insurance sector occur in the mediclaim policy segment and there is a need to adopt measures to reduce the trust deficit between insured and insurer, experts have said.

"In insurance industry, number of grievances received or number of frauds committed is an indicator of growth trend of particular segment. In entire insurance sector, 90 per cent of frauds and grievances come from health policies," said Niraj Kumar, General Manager, Oriental Insurance Company.

He was addressing a seminar on health insurance at Amity University yesterday. Kumar said if one has to draw two curves for health insurance segment, one indicating growth and second learning curve, it can be observed that the growth curve is ahead of learning curve.

This, he added, implies that industry's main aim is only to sell and market health policies, but there are important takeaways in such shortcomings so that the level of mistrust between insured and insurer can be minimised.

Richard Kipp, Managing Director, consulting firm Milliman said, health insurance in India has increased tremendously] over few years but India needs to be cautious in its growth vis-à-vis the US where growth has now become stagnant.

Neeraj Basur, Chief Financial Officer, Max Bupa Insurance

Company said that there is lack of trust level among hospitals, third party administrators, insurance companies and customers.

The trust level has to improve and all stakeholders have to understand that it is the customer whose interest is the binding factor, he added.

R R Grover, Advisor, Amity School of Insurance, Banking &Nine out of ten frauds in country's insurance sector occur in the mediclaim policy segment and there is a need to adopt measures to reduce the trust deficit between insured and insurer, experts have said.

"In insurance industry, number of grievances received or number of frauds committed is an indicator of growth trend of particular segment. In entire insurance sector, 90 per cent of frauds and grievances come from health policies," said Niraj Kumar, General Manager, Oriental Insurance Company.

He was addressing a seminar on health insurance at Amity University yesterday. Kumar said if one has to draw two curves for health insurance segment, one indicating growth and second learning curve, it can be observed that the growth curve is ahead of learning curve.

This, he added, implies that industry's main aim is only to sell and market health policies, but there are important takeaways in such shortcomings so that the level of mistrust between insured and insurer can be minimised.

Richard Kipp, Managing Director, consulting firm Milliman said, health insurance in India has increased tremendously] over few years but India needs to be cautious in its growth vis-à-vis the US where growth has now become stagnant.

Neeraj Basur, Chief Financial Officer, Max Bupa Insurance

Company said that there is lack of trust level among hospitals, third party administrators, insurance companies and customers.

The trust level has to improve and all stakeholders have to understand that it is the customer whose interest is the binding factor, he added.

R R Grover, Advisor, Amity School of Insurance, Banking &Actuarial Sciences, said there is an urgent need to address health insurance requirements of the urban poor.

‘DHARNA’ IN CHENNAI PRECEDING THE TWO - DAY STRIKE ACTION

As  a forerunner to the two-day strike on February 20 and 21, 2013 by the entire trade union movement of the country including the insurance employees against the anti-people and anti-worker policies of the Govt. of India heaping untold miseries on the nation’s population, a ‘Dharna’ programme was organised in front of the LIC Building, Chennai, by the ICEU, Chennai Division-I, from 2-00 PM to 5 PM on February 16, 2013. The meeting as part of the programme was presided over by Com.G.Jayaraman, President, ICEU, Chennai Division-I. The leaders including Com.N.M.Sundaram, former President of AIIEA and the gathering of employees present were welcomed by Com.S.Rameshkumar, General Secretary, ICEU, Chennai Division-I

Greeting the participants, Com. K.Swaminathan, General Secretary, South Zone Insurance Employees’ Federation, dealt with a wide variety of ills afflicting the nation due to the neo-liberal policies being ruthlessly implemented by the ruling coalition at the Centre. As far as the insurance and banking sectors are concerned, he recalled the days when these two vital sectors were in the hands of private big business magnets who indulged in all sorts of frauds forcing the Government of India to nationalise these sectors. The Government is now determined to entrust these sectors in the hands of the same private entities despite the   finance and insurance companies totally collapsing in the USA. He said that the Global Trust Bank, inaugurated by the Prime Minister when he was the Finance Minister of the country, was nowhere to be seen in the country.

Com.A.Soundararajan, CPI (M) MLA and General Secretary of the Tamil Nadu State CITU, blasted the policies of the Government, which had resulted in pauperisation of the country. He ridiculed the claim of the rulers that the country had achieved growth in employment and said that in the southern part of the country although it was claimed that two lakh new jobs had been created, not even 25% were permanent jobs and the salaries paid were very low. The rest of the jobs were on temporary, part time  and contract basis. He also made it known that even though the labour laws are not being enforced making it difficult to organise trade unions in newly formed industries, the CITU had succeeded in forming unions in several industries in Tamil Nadu.

The ‘Dharna’ programme, participated by a huge number of men and women comrades, came to a close with the vote of thanks proposed by Com. C.M.Kumar, Vice-President, ICEU, Chennai Division-I. A note-worthy feature of the whole programme was the presence of a large number of representatives of print and electronic media who interviewed the leaders and helped to give wide coverage for the issues involved in the two-day strike action.

Dharna on 16.2.2013 at Chennai

The All India Insurance Employees' Association has given a call to all its units through out India for two day general strike to be held on February 20,21/2013. The UPA government at the center is neglecting all the genuine demands of the workers.  All the welfare schemes for the betterment of the common man and workers are being scuttled by the government, saying that there are no funds for it.  In the name of enforcing fiscal discipline the poor of the nation was held to ransom by the rulers.  But at the same time a staggering sum of 5.28 lakhs of crores of rupees was given as largees to big corp orates and rich in the name of revenue forgone in the last budget. The sky rocketing of prices of essential commodities is pushing many people to starve. The central government recently liberalized the oil pricing mechanism and increased the rates of diesel and gas. This kind of attacks were unleashed against people on the other hand doles were given to the corp orates at the expense of common masses. To condemn this attitude of the central government all the central trade unions are coming together for first time in the history for this two day strike. The common demand of the strike is 

1.take effective steps to reduce the prices 

2.Withdraw the Insurance Amendment bill 2008

3.Withdraw the new pension scheme

4.Implement the Labour and trade union laws and recognize AIIEA  in LIC.

5.Give one more of option for pension

and there are other common demands.

A massive Dharna is being planned at Chennai on 16 th feb 2013 Saturday from 2.00 pm to 5.00 pm

Com.A.Soundarrajan ,MLA, Floor leader CPI(M). is participating in the Dharna program me. Com.K.Swaminathan, General Secretary, SZIEF is also participating.

Coaching classes for SC/ST Candidates

LIC has called for backlog recruitment of SC/ST candidates for the post of assistant. Throughout the zone there are 84 vacancies. In Chennai center there was a total of 18 vacancies. On behalf of ICEU, Chennai division-I, coaching classes were being held. More than 50 candidates are attending the classes regularly. The coaching class was inaugurated by comrade K.Swaminathan, general secretary, SZIEF on 26.1.2013. The meeting was presided by com.G.Jayaraman, President, ICEU, Chennai division-I, While comrade S.Ramesh Kumar  General secretary, ICEU, Chennai Division-I welcomed the gathering Com.D.Ramesh, Joint Secretary  and Coordinator for the coaching class proposed vote of thanks. More than 50 comrades attended the function. The coaching will be held till the 24 th of February 2013.

Tax violation notices served on Reliance Life, Sahara Life, other insurers 

New Delhi: Eight private insurance companies, including Reliance Life and Sahara India Life have been served show-cause notices by the Revenue department for alleged tax violation, Parliament was informed today.

The other insurance companies on which the Tax department has served show-cause notices are Aviva Life, DLF Pramerica Life, Sri Ram Life, IFFCO-TOKIO General Insurance, Apollo DKV and Bharat Reinsurance.

This was stated by Minister of State for Finance S S Palanimanickam in a written reply to the Rajya Sabha. Out of the eight companies, Reliance Life, DLF Pramerica, IFFCO TOKIO General and Bharat Reinsurance have submitted their replies to the government, he said.

Palanimanickam said: "In cases where the companies have submitted the reply, a personal hearing will be held and adjudication orders (will be) passed".

In cases wherein reply is yet to be submitted, the Minister said, personal hearings will be conducted after receipt of the replies of the companies.

LIC's record of paying claims better than pvt insurers: IRDA 

New Delhi: Life Insurance Company (LIC) has better record of paying death claims than that of private life insurers, said regulator IRDA in its latest report.

"The claim settlement ratio of LIC appeared to be better than that of the private life insurers", said Insurance Regulatory and Development Authority (IRDA) in its annual report 2011-12.

While LIC is the only life insurance company, there are about two dozen companies in the private sector which provide life cover.

According to the report, LIC has settled 97.42 per cent cases relating to death claims during 2011-12 compared to 89.34 per cent by private sector companies. The industry average worked out to be 96.26 per cent.

"Settlement ratio of LIC increased to 97.42 per cent during the year 2011-12 when compared to 97.03 per cent during the previous year," it said, adding that private insurers repudiated higher number of claims as compared to LIC.

On the positive side, settlement ratio of private insurers improved during the year to 89.34 per cent from 86.04 per cent in the previous year.

As far as industry is concerned, the settlement ratio increased marginally to 96.26 per cent in 2011-12 from 95.58 per cent a year ago.

LIC had 70 per cent market share in 2011-12 in the life insurance industry, while the rest is with 23 private sector players.