CIC asks United India Insurance to disclose information that may help close a loophole - I

United India Insurance denied cashless feature for few months after policy renewal citing data was not updated by the TPA. In the age of technology, this seems to be an insurer and/or TPA strategy rather than inefficiency

In a landmark judgement the Central Information Commission (CIC) directed United India Insurance Company (UIIC) to mandate all branch managers to put up on the company’s website information on date of issue of each mediclaim policy and date of transfer of the policy related information to the TPA (Third Party Administrator). It will surely enhance the transparency for all future policy purchases or renewals. This information is not mandated to be given for past policies and hence it is unlikely UIIC will comply for historical data. The CIC decision comes after one year of RTI (Right to Information) activism by Moneylife subscriber Dr Anshu Agrawal from Janakpuri, Bareilly, who finally got justice in the second appeal before the Commission on 28 June 2012.

This will surely put insurers and TPAs on the back-foot as this hide-and-seek game between insurers and TPAs has been the root cause of senseless denial of legitimate cashless feature for almost two-three months after each customer policy renewal. According to Dr Agrawal, “This ruling will soon be applicable to other insurers who operate through TPAs”. Dr Agrawal had filed an RTI application with the Insurance Regulatory and Development Authority (IRDA) to find if there were any guidelines on the time limit for the insurer to dispatch the policy copy to the TPA. According to RTI reply, “IRDA has not mandated any time limit.”

A delay of two to three months to give renewal information to the TPA and/or TPAs not updating their systems with renewal information leads to denial of cashless approval under an inexplicable excuse that the customer has not renewed the policy even though the insurer has encashed the payment cheque two to three months back. This is nothing short of cheating. What’s more disturbing is that this can even impact reimbursement claim.

According to another Moneylife reader, “United India has instructed its offices to send soft data, to the TPAs, of health insurance renewals once a month only, usually on the last day of the month. As a result when an insured is admitted to a hospital a week or two after his policy has been renewed and he contacts the TPA, he is told that as per their records his policy has not been renewed and therefore they are unable to register his claim even though he had called them within the mandatory 24-hour deadline! As a result he is also denied cashless facility and has to go in for reimbursement which again will be denied on the grounds that the claim was not reported within 24 hours!”

Dr Anshu Agrawal, says, “I tried to find out the working of a branch office of UIIC. If you buy one health policy on say 1st June, they receive bank statement only by 15th July. They take another 15 days for reconciliation of bank statement manually. Another one month is taken to download form 64VB from their website to fill it, copy it and despatch to the TPA. In the era of net-banking and e-mail communicability, UIIC is living in medieval era.”

Dr Agrawal got a cashless ID card from his TPA almost one year after buying mediclaim and that too after long persuasion with UIIC regional customer care department and couple of complaints on their website. The subsequent renewals despatch by UIIC was consistently after couple of months of expiry date of previous mediclaim. He was worried about claims denial in case there was medical need within the two-three months of policy renewal.

One year ago, Dr Agrawal sought information under RTI about mediclaim issue dates and policy despatch dates by the Bareilly branch office, how many days does it take for a health policy to be dispatched to TPA and whether cashless or reimbursement claim will be honoured if the TPA does not have policy renewal details. The answers to these questions may just startle you.

Read the second part of the article tomorrow to understand how UIIC CPIO still continues to evade giving information even after the CIC took the liberty of looking at the issue in larger public interest of all insurance policyholders to issue the landmark judgement.




5 years ago

This is a very serious problem and needs to be sorted out immediately. This is another way of looting the lay public and since United India is one of the public sector undertakings (govt) like any other government organisation there is no one to take responsibility for such deeds. There are umpteen number of cases where legitimate claims are denied for no fault of the customers. High time someone put a stop to this "daylight robbery"

ND Tiwari is biological father of Rohit Shekhar says HC

According to the DNA rest, ND Tiwari is reported to be the biological father of Rohit Shekhar and Ujjwala Sharma is reported to be the biological mother

New Delhi: ND Tiwari is the biological father of a Delhi-based youth Rohit Shekhar, the Delhi High Court on Friday said while declaring the result of the DNA test of the veteran Congress leader, reports PTI.
Justice Reva Khetrapal declared the result of the DNA test conducted at the Hyderabad-based laboratory in the open court and said as per the report, "Tiwari is reported to be the biological father of Rohit Shekhar and Ujjwala Sharma is reported to be the biological mother."

Before declaring the result of the DNA test, the report of the Centre for DNA Fingerprinting and Diagnostics (CDFD) was desealed in the chamber of the judge in the presence of advocates for Rohit Shekhar and his mother Ujjwala Sharma.


Though, the judge waited for the presence of Tiwari's lawyer, none appeared on his behalf.


While announcing the result of the DNA test in the open court, the judge noted that "None has appeared on behalf of Defendant No 1 (Tiwari) though it is nearly 4 pm, nor any request has been made for an adjournment on behalf of defendant No 1.

"Accordingly let the sealed cover, received from CDFD, Hyderabad be opened and the report be placed on the file, which would be available to the parties only".


The counsel for 32-year-old Shekhar and his mother had informed the judge that a division bench of the high court earlier today had rejected 87-year-old Tiwari's plea not to open the DNA report before a single judge bench, adjudicating the paternity suit.


The division bench had allowed Justice Reva Khetrapal, who had decided to open Tiwari's DNA report and to declare the DNA test result in open court.


Dismissing Tiwari's appeal against Justice Khetrapal's 19th July decision, a division bench of Acting Chief Justice AK Sikri and Justice Rajiv Sahai Endlaw said, "Not opening the DNA report may lead to a lengthy process".


Concurring with the single judge's observation on Supreme Court's direction to maintain confidentiality on Tiwari's DNA profile, the bench had said, "We are in agreement with the single judge that nowhere the Supreme Court in its order stated that the DNA profile shall be kept in a sealed cover till the conclusion of trial. This DNA report is a piece of evidence.."


"The purpose was to cut short the controversy and to avoid an unnecessarily prolonged trial. If the sample is not opened now, it may lead to unnecessary cross-examination of the witnesses. We do not find merit in the petition, so it is dismissed," the bench had added.


Tiwari's counsel and senior advocate Mukul Gupta had sought quashing of the single judge's order or to provide protection till the Supreme Court clarifies its 24th May order on the issue of confidentiality.


The senior lawyer submitted to the bench that after the single judge dismissed their plea to conduct the trial in-camera and also to keep the DNA report confidential, they have filed an application before the apex court, which is yet to hear their plea.


Opposing Tiwari's plea, plaintiff Rohit Shekhar's lawyer Amit Sibal had said, "DNA report is a scientific evidence and the truth should come out as early as possible."


He had further submitted that Tiwari is an old man and if anything happens to him, the suit will become infructuous.


Accordingly, the court must decide the matter at the earliest, he had added.


After hearing all the submissions, the bench had told Tiwari's counsel, "It is a piece of evidence, how can you say that the piece of evidence can't be opened. It is an open trial and the evidence has to be recorded."


In his appeal, Tiwari had pleaded with the court to protect his "right to reputation," contending that the single-judge bench has adopted a "shortcut" to decide the suit and it would cause "grave injustice" to him.



TCS topples ONGC to become most valued company in India

Market cap of TCS increased to Rs2.39 lakh crore, pushing ONGC to second spot with a market cap of Rs2.37 lakh crore. RIL is at third position with a market cap of Rs2.36 lakh crore, while Coal India and ITC are at fourth and fifth place with market cap of Rs2.23 lakh crore and Rs1.99 lakh crore, respectively

Mumbai: Software services exporter Tata Consultancy Services (TCS) on Friday toppled state-owned Oil And Natural Gas Corp Ltd (ONGC) to become the country's most valued company with its market capitalisation soaring to over Rs2.4 lakh crore, driven by a spurt in share price, reports PTI.
At the end of trading on Friday, TCS commanded a market value of over Rs2,39,906 crore, the highest for any listed company in India. This is about Rs2,577 crore more than ONGC's market value of around Rs2,37,329 crore.
A sharp gain of 1.9% in TCS's share price today pushed the company to the top slot. In comparison, ONGC, closed at Rs277.4, almost flat compared to its previous closing price.
Market capitalisation of a listed company corresponds to the cumulative market price of all its shares. This figure changes daily with the change in the stock price.
Reliance Industries with a market capitalisation of Rs2.36 lakh crore stood at the third position, followed by Coal India (Rs2.23 lakh crore) and ITC (Rs1.99 lakh crore).
Meanwhile, private sector lender HDFC Bank on Friday surpassed state-run State Bank of India (SBI) as the country's most valued bank with a total market valuation of about Rs1.4 lakh crore.


We are listening!

Solve the equation and enter in the Captcha field.

To continue

Sign Up or Sign In


To continue

Sign Up or Sign In



The Scam
24 Year Of The Scam: The Perennial Bestseller, reads like a Thriller!
Moneylife Magazine
Fiercely independent and pro-consumer information on personal finance
Stockletters in 3 Flavours
Outstanding research that beats mutual funds year after year
MAS: Complete Online Financial Advisory
(Includes Moneylife Magazine and Lion Stockletter)