A bench of the District Consumer Disputes Redressal Forum presided by NA Zaidi said private insurance companies are denying medical claims “as a matter of routine” on pretext that insured person suffered from a pre-existing disease
New Delhi: Irked by large number of denial of rightful medical claims to customers by various private insurance firms, a district consumer forum has asked the Centre to examine the issue and take action against erring firms to protect customers’ interest, reports PTI.
A bench of the District Consumer Disputes Redressal Forum presided by NA Zaidi said private insurance companies are denying medical claims “as a matter of routine” on pretext that insured person suffered from a pre-existing disease.
“We are noticing that a large number of cases are coming in the matter of medical insurance. The private insurance companies as a matter of routine are rejecting the bonafide claims of the policyholders, taking up the plea of pre-existing disease. Their main objective is to deny the benefit to the customers to which they are entitled under the policy.
“It requires consideration by the Government of India and to initiate action against the private companies in the filed of insurance business and to check them from making illegal gains by denial of bonafide payments to the customers.
“The ministries of health and finance and the Government of India are requested to take this into consideration and take suitable remedial action to protect the interest of the consumers,” the consumer forum said.
The forum passed the orders while directing Star Health and Allied Insurance Company, a Chennai-based company, to pay Rs20,000 as compensation to Prem Priyaardhan, a Delhi- resident, for subjecting him to “harassment and mental tension” by denying his bonafide right and due medical claim.
It also asked the company to pay Rs28,000, the medical expense incurred by Mr Priyaardhan on his child’s treatment.
The forum passed the judgement on Mr Priyaardhan's complaint that the insurance company had denied the claim amount for his son’s treatment on the pretext that his son was having an undisclosed pre-existing disease of tuberculosis while the medical reports indicated that the child was admitted only due to the cold and severe fever.
He said he had purchased the policy in January 2011 and the company denied the claim in April same year.
Before the forum also the company said their doctors were of the opinion that child suffered from pre-existing tuberculosis which was not disclosed at the time of purchasing the policy and hence there was no deficiency on their part.
The consumer forum, however, held “it is incumbent upon the insurance company to examine the person thoroughly when the policy is being sold.”
The forum said the doctors of insurance company normally examine the person buying the policy and those covered by that policy and there was no such report placed on record to show that there were any symptoms that the child had tuberculosis at time of the sale of the policy.
“The infection may be caught by any healthy person anywhere at any time. We are living in a society where the level of pollution is very high, causing lot of complications with the respiratory system,” the forum said.
“It cannot be ruled out that after buying the policy, child was exposed to the bacteria of tuberculosis and thereby resulting into infection caused by such bacteria,” it added.
The forum also ordered that a copy of this judgment be sent to the secretaries of the ministry of finance and the ministry of health “for necessary action at their end”.
Reversal possible if the Nifty closes firmly above 5,376 tomorrow
Value picking by institutional investors, after a steep decline in the previous session, enabled the market snap its four-session losing streak. Today the benchmarks were able to recover more than half the losses suffered yesterday. However, this may not be taken as a reversal. For a reversal to be seen, the Nifty should close firmly above today’s close of 5,376. If the downtrend continues, we may see the index moving in the range of 5,150 and 5,400. The National Stock Exchange (NSE) saw a volume of 86.10 crore shares.
The local market, which recorded a sharp fall yesterday, bounced back this morning as investors resorted to bargain hunting at lowers levels and on positive cues from the Asian pack. Banking, realty and metal sectors, which were badly mauled in the previous session, witnessed good buying interest today. The Nifty opened trade at 5,311, up 30 points, and the Sensex rose 99 points at the opening bell at 17,545.
The market touched its intraday low in initial trade itself with the Nifty falling to 5,306 and the Sensex going back to 17,530. However, no damage was done as the indices resumed their upmove in subsequent trade. Across-the-board buying resulted in 12 of the 13 sectoral gauges trading in the positive in morning trade.
A firm opening of the key European indices helped the local benchmarks extend their gains in post-noon trade and scale their intraday highs. At the highs, the Nifty touched 5,391 and the Sensex rose to 17,777.
Snapping the four-day decline, the market settled with good gains but off the day’s high. At the close, the Nifty gained 94 points at 5,376 and the Sensex finished at 17,731, a jump of 285 points.
The advance-decline ratio on the NSE was in favour of the gainers at 1409:344.
The broader indices outperformed the Sensex today; the BSE Mid-cap index jumped 3.40% and the BSE Small-cap index surged 2.78%.
BSE Realty (up 5.91%); BSE Capital Goods (up 4.02%); BSE Bankex (up 3.93%); BSE Power (up 3.57%) and BSE Metal (up 3.43%) were the top sectoral gainers while BSE IT (down 0.56%) and BSE Fast Moving Consumer Goods (down 0.13%) were the losers.
The key gainers on the Sensex were BHEL (up 6.74%); Hindalco Industries (up 4.97%); State Bank of India (up 4.92%); Tata Motors (up 4.85%) and DLF (up 4.78%). TCS (down 1.80%); Wipro (down 0.93%); ITC (down 0.80%); NTPC (down 0.36%) and Sun Pharma (down 0.34%) were the key losers.
The Nifty was led by Reliance Infrastructure (up 13.08%); Reliance Power (up 7.95%); Jaiprakash Associates (up 7.43%); Reliance Communications (up 7.40%) and IDFC (up 7.27%). Cairn India (down 2.71%); TCS (down 1.95%); ITC (down 0.87%); BPCL (down 0.86%) and Sun Pharma (down 0.79%) settled lower on the index.
Markets in Asia closed mostly higher on easing of oil prices for the second day and on reports that the China Banking Regulatory Commission has allowed banks to continue lending to local government financing vehicles for land reserves and road construction.
The Shanghai Composite rose 0.20%; the Hang Seng jumped 1.65%; the Jakarta Composite surged 1.10%; the Nikkei 225 climbed 0.92%; the Straits Times advanced 0.78%; the Seoul Composite gained 0.63% and the Taiwan Weighted added 0.28%. Bucking the trend, the KLSE Composite fell by 0.15%. At the time of writing, the key European indices were trading with marginal gains and the US stock futures were in the positive.
Back home, foreign institutional investors were net buyers of shares amounting to Rs329.09 crore on Monday whereas domestic institutional investors were net sellers of equities totalling Rs699.14 crore.
Tata Power said the first 800 MW unit of its flagship 4,000 MW Mundra UMPP has achieved full capacity utilisation and commercial date of operation would be announced soon. The 4,000 MW Mundra plant in Gujarat is the country’s first Ultra Mega Power Project (UMPP). The first 800 MW unit of Mundra project achieved full load on 25th February. The stock gained 2.19% to close at Rs111.95 on the NSE.
Orchid Chemicals & Pharmaceuticals today said it has redeemed outstanding overseas securities worth $167.64 million (over Rs820 crore) on the due date. The company has redeemed the outstanding Foreign Currency Convertible Bonds (FCCBs), including yield-to-maturity, aggregating $167.64 million on the due date, 28 February 2012, Orchid Chemicals said in a statement. The Chennai-based firm had issued the bonds in February 2007. The stock jumped 5.15% on the NSE and closed at Rs188.
Pennar Industries has developed new product lines and has received orders amounting to Rs16 crore. The company has received order for Air Pre-heater Tubes from clients including BGR Energy, GEI Industrial Systems, FIVESCAIL-KCP and Nu-way Heatransfer. The stock climbed 5.96% to settle at Rs32 on the NSE.
Max Bupa’s Heartbeat High Deductible plan is only the second of its kind in the market after United India’s super top-up medicare. The product is attractively priced and will appeal to a specific market segment
Max Bupa Heartbeat High Deductible Policy is a super top-up policy, which will compete with United India’s super top-up medicare. While the concept of a top-up or super top-up policy is yet to catch on in the market, Max Bupa’s research showed that there is customer demand for such a product. It is a good concept for those who are already covered by a corporate or retail health insurance policy and wish to go for higher coverage. This product is also useful for someone without mediclaim who is willing to pay for medical expenses up to the high deductible barrier (Rs2 lakh or Rs3 lakh) before the super top-up policy kicks in to pay for additional medical expenses.
Heartbeat will have a standard pre-existing disease waiting period of 48 months like any other mediclaim policy. The high deductible option can be availed for the entire family, including parents to top-up their already existing health insurance policy. Max Bupa’s super top-up policy offers a deductible amount of Rs2 lakh or Rs3 lakh. The customer can choose the coverage amount above this limit as per their need. The premium will be based on the deductible limit and the coverage amount over the limit. For e.g. a 35 year old male going for a deductible amount of Rs2 lakh and coverage of Rs2 lakh over the limit will pay an annual premium of Rs1,503. The customer can also opt for a two-year policy tenure. The same person, going for the same deductible sum and coverage of Rs3 lakh over the limit in United India’s super top-up medicare will end up paying a premium of Rs2,317. In effect, Max Bupa offers a competitive alternative.
What is the value that a top-up and super top-up policy brings to you? One way to get additional cover could be to buy another health insurance policy. But this may be too expensive. There are other alternatives as well. For instance, one was buying a top-up plan which would provide an additional cover to add to your existing cover in a very economical way of getting higher insurance cover. The thing to note here is an amount called the “threshold level”, also known as the “compulsory deductible” amount. This is the level above which the top-up can be utilised to pay for the expenses.
For example, for a top-up amount of Rs10 lakh and the compulsory deductible amount is Rs3 lakh; the top-up amount will pay only for expenses above Rs3 lakh up to Rs10 lakh. Super top-up is also like a top-up policy. The difference between the two is that in the case of a top-up policy the expenses for a single treatment should be over the threshold, whereas in a super top-up the total expenses in a year must be above the threshold level for the policy to be effective. Thus, between a top-up and super top-up, the super top-up is more beneficial for customers.
There are four companies that provide top-up policies: United India Insurance (Top-up medicare), Bajaj Allianz (Extra Care), Apollo Munich (Optima Plus) and Star Health and Allied Insurance (Super Surplus). Of the three, only United India had a super top-up plan (Super top up medicare). Now, Max Bupa Heartbeat High Deductible product offers super top-up plan.