File your mediclaim within seven days, or else…

Did you know that many insurers allow only seven days after hospital discharge to submit reimbursement claims? These rules are now being enforced strictly. Policyholders should be aware that a delay may invalidate their claims

Did you know that many insurers allow only seven days for submitting reimbursement claims or mediclaim after discharge from a hospital? While private sector insurers are reportedly following the practice, now public sector insurers are also planning to do the same in order to curb fraudulent submissions.

G Srinivasan, chairman and managing director, United India Insurance Co Ltd told Moneylife, "It (mediclaim submission) was already implemented by a few companies in the market. We are starting to enforce the same to have control over claims. When a policyholder is admitted to a hospital, we need to know so that we can talk with doctors or do our investigations. The time limit for submission of claims should not be too long. If there are genuine reasons for delay the policy conditions can be waived at various levels. It will help in fraud control. If there are post-hospitalisation bills, they can be submitted as a separate claim later."

This means, whether the patient has fully recovered or is still undergoing post-hospitalisation treatment, he or his caretaker will have to submit the mediclaim within seven days from hospital discharge. Moreover, the claim may have to be filed in person or couriered to avoid any delays concerning postal services. Strict enforcement of this move is likely to cause inconvenience for policyholders.

According to the standard mediclaim policy, expenses incurred 30 days before hospitalisation and 60 days after discharge are payable as per the policy terms and conditions. Post-hospitalisation claims may have to be separate from the hospital claim.
Insurance companies have a point that delay in claims submission helps fraudsters to cook up fake documents that adversely impact insurers' claims ratio. The flip side is any genuine delay in claim submission will now need authorisation and hence additional red tape for it to be accepted by an insurer.

According to M Ramadoss, chairman and managing director of The New India Assurance Co, "There are time limits for intimation of the claim and submission of claim papers as per policy conditions which may differ between companies. Such time limitations are put in all policies."

Many insurance companies mandate policyholders to contact them or the TPA (third party administrator) within 24 hours of hospitalisation. In addition, insurance companies are also not obligated to send the policyholder renewal notices. The onus is on the policyholder to be aware of his own responsibilities and the fine print in his mediclaim policy.

The United India Insurance circular specifies claim documents have to be submitted within seven days from the discharge date. Any delay up to 15 days can be condoned by the divisional manager. Beyond 15 days, the power to condone has been vested in the hands of the regional officer.

According to a New India Assurance individual mediclaim policy, preliminary notice of claim should be given to the company/TPA within seven days from the date of hospitalisation for reimbursement claims. Final claim along with hospital receipted original bills/cash memos, claim form and list of documents as listed in the claim form etc., should be submitted to the policy-issuing office/TPA not later than 30 days from hospital discharge.

According to Rohan Dukle, director, Magus Corporate Advisors Pvt Ltd, an insurance claim consultancy firm, "With the total de-tariffing of the non-life industry post-2006, resulting in major price wars in hitherto profitable segments such as fire, engineering (insurance) etc., there is increased pressure on the bottom lines of insurers. This coupled with the lower ceding commissions has resulted in tremendous pressure on the insurers, forcing them to reconsider pricing. With the constant influx of new entrants into the non-life segment, this pressure is not expected to immediately reduce. As such therefore the insurers are being more stringent in passing of claims. This stringency is even more evident in the case of mediclaim which is repeatedly seeing high incurred claim ratios."

"Traditionally, in a tariffed regime, it was seen that the insurers followed the policy of 'pay if you can, reject if you must'. With the exigencies of the current scenario, this policy is slowly seeing a change, with insurers taking a close look at the fine print whenever there is a claim. With the redressal mechanisms such as consumer courts or civil courts (in case of rejected claims) taking substantial time to provide relief, insurers may tend towards rejecting claims in case of borderline claims," he added.

It has been reported that New India Assurance will approach the Insurance Regulatory and Development Authority (IRDA) to allow it to curtail the stipulated period for submission of claim papers from the existing 30 days to seven days.



Frustruated Indian

6 years ago

Forget about submitting claims within 7 days. My claim was rejected because I had not intimated over email or fax to the TPA within 24 hours of hospitalisation.

Wow, that means I need to be sane enough when i am suffering a 105 degree fever and call up my agent or my TPA, inform them, or better still leave the hospital premises, look around for a cyber cafe, to post my details. And what luck, if I was to get stuck in a remote town or village and have no communication facility to inform the TPA. Bull shit insurance. I would rather stick to my bank account and mutual fund investments.

P.S. An friends life insurance policy death claim got rejected after continuously paying premiums for 8 straight years. His bereaved wife, doesnt even get back the premiums paid. Rather he had invested in a bank account, his survivors atleast get the money back.

India offers 34 oil & gas blocks for exploration under NELP-IX

New Delhi: India today offered 34 oil and gas blocks for exploration in the 9th round of New Exploration Licensing Policy (NELP), reports PTI.

"The government is offering 34 blocks covering an area of 88,807 sq km," petroleum minister Murli Deora said. "The last date for bidding for the blocks offered under NELP-IX is 18 March 2011."

The blocks being offered include eight deep-sea, seven shallow-water and 19 on-land, the minister said. The on-land blocks include eight small ones and there is a technical qualifying criteria for companies intending to bid for these blocks. The first road show for NELP-IX will be held in Mumbai on 18 October 2010.

In the eight rounds of NELP since 1999, 235 blocks have been awarded. This has resulted in enhancement of exploration coverage from 11% to about 58% of the Indian sedimentary basin between 2000 and 2010.

"The discoveries made under the NELP have resulted in in-place hydrocarbon reserve accretion of a staggering 642 million tonnes of oil and oil equivalent gas," Mr Deora said.

A total of 87 oil and gas discoveries have been made in only 26 of the blocks under NELP so far. Out of 81 oil and gas discoveries, natural gas production at Reliance Industries' eastern offshore KG-D6 block commenced from April 2009.

The eighth round of bids, which closed on 12 October 2009 attracted an investment commitment of $1.34 billion for 36 blocks that received offers. Under NELP-VIII, 70 areas or blocks for exploration were offered, the biggest licensing round in India. Of the 36 areas bid for, the government awarded 33 to successful bidders.


ASCI acts against RCom, Polo and LMN ads

Says the campaigns are objectionable and misleading; also asks J&J and Scorpio Enterprises to modify advertisements for making unsubstantiated claims

The Advertising Standards Council of India (ASCI) has found objectionable three advertising campaigns by Reliance Communications for its internet CDMA plans, Volkswagen for its Polo vehicle and Parle Agro for LMN juice, and directed that they be discontinued. ASCI has also asked Johnson & Johnson and Scorpio Enterprises to modify their advertisements.

The advertising self-regulatory body has taken these decisions on complaints received by its consumer complaints cell and announced in its report for May-June 2010.

The Reliance Communications advertisement aired on television claimed that net calls are unlimited and that the CDMA plan allowed unlimited talk time. However, according to the complaint, it was discovered that these plans were in fact subject to conditions that were not mentioned in the ads.

Volkswagen's campaign test drives the new hatchback Polo car against rhinos and buffaloes. The advertisement tries to highlight the car's ability on rough roads with an invitation to drive the vehicle to a wildlife sanctuary. "...Search for the meanest rhino. Inch the Polo towards the rhino. Take a deep breath and blast the horn as hard as you can." Similarly, the ad featuring buffaloes says, "Gather buffaloes on both sides of the road. Get a friend to whack them on their rear. Drive as fast as you can through the herd. Slip under the Polo as the herd thunders past you." ASCI said the ads portrayed violence against animals and were against the Performing Animals (Registration) Rules 2001. The campaign was produced by DDB Mudra.

The television commercial for LMN juice pictures undernourished people at a dry, parched African site, scrounging for water. The people have been shown as being deprived of water and they are depicted as stupid. The catch-line is, "If you don't have water, drink LMN juice". This portrayed the African nations in a bad light and could be viewed as racist, ASCI said. The LMN commercial was done by Creativeland Asia. These three advertisements have since been withdrawn.

ASCI said that advertisements with claims that might not be exclusive to one particular product can mislead consumers. This is what happened with the Johnson & Johnson television commercial for Stayfree Secure Ultra Thin Napkins. It claimed that a super- absorbent polymer converts the heavy flow into gel form and is locked. It pointed out that this benefit is also available from other sanitary napkins that do not have a super-absorbent polymer. Therefore, the company was asked to modify the commercial.

Scorpio Enterprises was also asked to modify its ad for Natraj Atta maker that made misleading claims. The ad, which was published in the Gujarati media, suggested that using the atta maker saves grains by up to 25%, but this is not substantiated. It also said that it costs only 60 paise to grind 1kg of fine flour with a Natraj atta maker.

ASCI also received complaints against campaigns by Mankind Pharma Ltd (Don't Worry Sanitary Pads), Kalyan Jewellers, State Bank of India (The Banker to Every Indian), Bajaj Allianz Life Insurance Co Ltd (Bajaj Allianz Shield Plus) and TIME (IIT-JEE 2011/2012). However, the Council felt that these complaints were not substantiated and therefore no action was taken. 


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