Insurance
New India Assurance pays Rs34,313 for mediclaim initially rejected: Another Moneylife success
New India Assurance has paid Rs34,313 towards a mediclaim that was earlier rejected by the TPA on flimsy grounds. The insured senior citizen has been a customer for 20 years, but that did not help to get the claim paid. Moneylife Foundation’s intervention helped
 
Sujit Banerjee (name changed), a retired senior citizen of 73 years, had approached the Moneylife Insurance Helpline of Moneylife Foundation seeking help with his rejected mediclaim on flimsy grounds by the TPA (third party administrator). The TPA alleged that the insured suffered from hypertension for 15 years without having any documentary support. The TPA even chose to ignore medical certificate of the illness from a doctor with super speciality degree in neurology. Inadequate medical expertise of the TPA staff has been reported by the media for a long time.
 
Taking the complaint to the grievance cell was the next step followed by the Moneylife Insurance Helpline in escalating the matter to the GM, grievance cell of New India Assurance. The claim was paid for Rs34,313, overturning the TPA’s debatable decision.
 
The case proves that TPAs should not be settling claims, which is included in the new health insurance guidelines from IRDA (Insurance Regulatory and Development Authority). Insurance companies have much more expertise on medical intricacies than a TPA. The regulations put the onus on the insurer to give specific grounds of settlement and denial of claim. In short, the insurance company cannot play the blame game that the TPA is making decisions on the claims.
 
MD India (TPA) had repudiated Mr Banerjee’s for a claim related to illness of reversible ischemia with neurological deficit, arguing that the “Current illness is a complication of hypertension which is since 15 years as per indoor case papers’’. According to Mr Banerjee, “I do not know from where the TPA got this information as neither the case papers nor the discharge card made any reference of 15 years history of hypertension. Somewhere a mention is made of mild hypertension which is natural as an age-related problem.  I am a customer of New India Assurance for the last 20 years or so.”
 
On receipt of the TPA repudiation letter, Mr Banerjee contacted Dr Neeta A Mehta, under whom he took treatment at Nanavati Hospital in Mumbai. She readily issued a certificate mentioned that the illness was “more like Transient Ischemic Attack” and further added that “mild fluctuation of blood pressure is not the cause of this attack’”. Mr Banerjee says, “Dr Neeta Mehta is an eminent neurologist of repute and besides being an MD also holds a super speciality degree of DM in Neurology. I wonder how the TPA can ignore the opinion coming from such an eminent doctor.” Moneylife’s contribution helped to get justice for Mr Banerjee.
 
Interestingly, at a January 2013 high court hearing of a public interest litigation (PIL) filed by Gaurang Damani, IRDA member (non-life) M Ramaprasad admitted that even veterinarians are appointed by the TPAs in addition to ayurvedics and homeopaths to assess claims. There have been cases where specialist doctors were not able to convince the need of specific procedure to TPA doctors, who may be well qualified in their respective field but not in the specialised allopathic stream.
 
Mr Banerjee also pointed out that all New India Assurance mediclaim policies showed no pre-existing diseases except for the policies for the years 2009-10 and 2010-11 which erroneously showed ‘’pre-existing hypertension and diabetes’’. Mr Banerjee thinks that it may be due to a clerical error inadvertently inserted and the loading was recovered. He had to protest for such a fallacy and the pre-existing illnesses were removed in the subsequent policies till today. It affirms what Moneylife suggests about the importance of checking your policy document so that there is no discrepancy in the product renewed or sold to you.

 In case you have an insurance issue, please write to Moneylife Foundation. Click here

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COMMENTS

ABHA CHAWLA MOHANTY

4 years ago

THE PUBLIC SECTOR INSURANCE COMPANIES ARE NOT SERIOUS ABOUT CUSTOMER CARE, AND ,POLICY PERCEPTIONS THEREIN FOR DOING GOOD....,NEED ,STRINGENT CHECKS FOR CALLOUS WORKING...!

revribhav

4 years ago

The General Insurance sector of india is virtually without any regulator.
(a) The IRDA: It's grievance redressal is without any teeth.It has told the Central Information Commission that it is not an authority over a particular insurance company.
A particular divisional manager of an insurance company who got me dismissed from insurance company has made himself millionaire on account of suspicious mediclaims.
(b) GIPSA: It is not registered with any statutory authority,you cannot legally sue GIPSA,though it is virtually an authority over 4 general insurance companies and GIC
(c) Ministry of Finance Insurance Division:It has told me in writing that it is not a complaint redressal authority over insurance company,though as per the General Insurance Act,it exercises administration over the insurance companies.

REPLY

ABHA CHAWLA MOHANTY

In Reply to revribhav 4 years ago

THE INSURANCE SECTOR ESPECIALLY PSU NEEDS A VERY UPRIGHT VIGILANCE AND ,AUDIT TEAMS WITH CAG MONITORING....?

SATISH BHATIA

4 years ago

Dear Money life Team, Thank you very much for sharing the experience of Mr. Banarji. I has really given so many points to re-check with policy, which will definitely be an eye opener for us.
It has marked a big question on TPA's and their services. As now days many cos are working without TPA.. can be a better solutions for customers.
Thanks n Regards,

Satish Bhatia
Advisor
Max Bupa

revribhav

4 years ago

While filing right to information I discovered a horrible fact about the said insurance company.
The well known bribe taker obiviously protected at the highest level showered with public money who was caught red handed demanding gratification during January 2003 near Jaipur regional office by a reputed law enforcement agency against corruption enjoys an altered name.
His present name is altered,that is,not the name with which he entered the services of insurance company.

REPLY

ABHA CHAWLA MOHANTY

In Reply to revribhav 4 years ago

DUTY OF DISCLOSURE STILL APPLIES...MAY THE NAME SURFACE FOR GOOD,,,,

revribhav

4 years ago

The said insurance company dismissed me on a so called grave allegation of leaving headquarters,the company chairman was seen in the company of a well known bribe taker who still receives public money of about 50K salary under salary roll no. 26019.Evidence may be seen at the following URL:
https://twitter.com/revribhav

Arun M Purohit

4 years ago

MANY THANKS TO MONEYLIFE FOR SUCH A HELP TO NEEDY SR.CITIZENS , CONGRATS , MONEYLIFE ALSO NEEDS TO TAKE UP THE MATTER REGARDING AGENTS / EMPLOYEES WHOSE DOESN'T HAVE IRDA LICENSE RECRUITED MOSTLY BY PVT. INSURERS , THEY ARE JUST A 10th / 12th PASS / GRADUATE ONLY. AS PER MY OBSERVATIONS AND LOOSING MINE BUSINESS TOO BY MY RELATIVES. I PERSONALLY POINTED OUT TO PVT. INSURERS , THEY CONVIENNCED ME THAT FOR HEALTH INSURANCE SELLING , LICENCE NOT REQUIRED. TILL DATE I LOST A PREMIUM OF Rs.50,000/- , MY COUSIN SELLING A RELIGARE HEALTH INSURANCE POLICIES AND TARGETTING MY CLIENTS ,HIS RM FROM RELIGARE ALSO DOESN'T HAVE IRDA LICENSE. THEY ARE MISSELLING A PRODUCT WITHOUT DISCLOSING IT'S NORMS. I AM EXPECTING A PROMPT ACTIONS FOR THE BENEFITS OF ENTIRE INDUSTRIES.

ARUN PUROHIT - IRDA QUALIFIED / AGENT OF THE ORIENTAL INSURANCE M : 09377702264 ,

Venkatesh

4 years ago

They shd also be fined for a few crores as penalty for rejecting a genuine claim. This will only make them more accountable. With this case what has been achieved? THe insurance company number crunchers will tell the TPA to reject over 75% of the claims, of which only 50% will fight back of which they can still reject 25% and end up with 50% claim rejection thereby lining their pockets. What I would also like to know is, does IRDA monitor these claim rejection percentages and is there transparent data on this available anywhere companywise ???

raj

4 years ago

Thanks for all the comments!

vinay kashelkar

4 years ago

As per my knowledge (if New India's terms and conditions are not different) any disease pre-existing at the time of proposal is not covered for first 4 years if continuous renewals without break are done. But from the 5th year all pre-existing diseases are automatically covered. There is no question of denying any claim for pre-existing diseases/tendencies.

vns

4 years ago

Retired people belonging to PSUs and having Mediclaim Insurance must thank Moneylife which stands to help those who are sr. citizens and really needy for such a help.Alternative is that Mediclaim Insurance companies combined with the TPAs will fleece the poor chaps.

vivek sharma

4 years ago

Great work Raj! Moneylife team believes in helping needy which is indeed great.

Anil Paranje

4 years ago

Great work MoneyLife! God bless!

N Kanitkar

4 years ago

Well done Moneylife. Hearty congratulations. Shoddy job from New India Assurance. Thanks to your earlier article on Mediclaim, chose the same from OBC at half the premium.

VPS Advisory promises 20% assured return. Is SEBI on vigil?

The advisory firm asks people to share their username and password of demat account so that it can trade on behalf of them and give a 20% assured return.  Is the market regulator keeping an eye on such entities?

The Securities Exchange Board of India (SEBI) which bars even mutual funds from assuring returns seems clueless about promises and claims of investment advisors such as VPS Advisors. A marketing email from an advisory company known as VPS Advisory, promises 20% returns.
 

The company claims it has a technique of making 20% profit consistently. The marketing mailer, full of grammatical mistakes, even mentioned that it never makes a loss. It said, “Overall at any worst case we make profit and come out.” For this, you will need to open a trading and demat account through them or give your demat account, along with the username and password! Also, in order for them to manage your account, you are required to keep a minimum capital of Rs50,000 in either your trading account or Rs50,000 worth of equity in your demat account. It is not too hard to figure out the ramifications of allowing someone else control your trading and demat account especially when they know your username and password.

 


VPS Advisory also gives the answer about how it can manage to provide 20% assured return. It says, “because of group of people trading with us with huge money flow keeps us in profitable situation.” This claim even may make market gurus, like Warren Buffet, blush. ‘People with huge money’, however, is no guarantee that they would share their profit with someone like you.
 

The advisory targets savers who do not have money but want to make more money. Their email states: “This service is basically for those who have less capital to invest but want to make more money. Or for small investors who are looking for consistent return.”

“20% return service is perfect for small investors, fixed salaried people (who have limited salary and unlimited expenses) and EMIs, loans, for government employees, etc,” VPS Advisory mail adds.
 

It is pertinent to note that the company claims to be ‘pioneered’ by the graduates of the Indian Institutes of Management (IIM) and Indian Institutes of Technology (IIT).
 

The company has even posted screenshot of several costumers’ trading and demat account. The notion of leaving others to control your personal trading account is simply appalling. Here, you can see it by accessing this link: http://www.vpsadvisory.com/p/20return_9178.html.
 


 


 


This is not the first time we wrote about such firms big on ‘guarantees’ with promises of lavish and ‘assured’ returns. We had first exposed about the Stockguru scam, which promised investors 120% returns, way back in 2010 (), but regulators did nothing then. Fast forward to present and what has the regulator learnt? Instead, the Stock Guru duped investors to the extent of Rs1,500 crore! Back then, Stockguru was offering Rs22,000 on an investment of Rs10,000 in one year, and called itself investment advisors. Unfortunately, the lack of financial literacy and regulation meant investors fell for it. And lost money. The entire saga as exposed by Moneylife can be read here:
 

Very often there would be similar operators who would solicit stock market tips on mobile phones and claim more than 90% accuracy. For instance, a website CallOptionPutOption provides such trading tips ranging from stock options to Nifty Futures tips and Nifty Options tips. It claims over 200% profit per month. For this ‘plan’, capital of Rs10,000 is required and tips are provided with one target price and one stop-loss. Subscription to this scheme ranges from Rs3,000 to Rs30,000, depending on the plan you choose. There are many more that we had covered way back in 2011, and our piece can be accessed here:
 

Three years later, the scene hasn’t changed much. Is SEBI listening?
 

We had reported several similar companies and they can be accessed below:
 

Now MLM selling assured returns for kits on share trading! -- A write up on BSB Trading,
which promised dubious double your money in a matter of months.
 

From exchanges to MLM swindlers: Why are all of them so enamoured by forex trading?
 

Hyderabad-based Variety Consultancy promised 15% return on investment per month
for buying its forex and commodities training packages

 

User

COMMENTS

R Balakrishnan

4 years ago

Another from the BAD city of HyderaBAD. Should tell you the story..

ABHIK DE

4 years ago

CAN A BANK ACTING AS BROKER OF BANKASSURANCE SELL ULIPS WITHIN WEEKS OF ADVISING INVESTOR TO SURRENDER RUNNING ULIPS.AS PER IRDA GUIDELINE,NEW POLICY/POLICIES CANT BE SOLD FOR 3YRS.AFTER SURRENDERING/TERMINATING EXISTING POLICIES. NEW ULIPS SOLD /MIS-SOLD OF SAME SCHEME WITH 50% ALLOCATION CHARGES,1ST YR.FOR EG.IF THE PREMIUM IS 200000/-,ENTRY LOAD IS 1LAC.JUST TO EARN REVENUE!BANK BEING THE PORTFOLIO MANAGER/INVESTMENT ADVISOR.ANY COMMENT?

REPLY

ABHIK DE

In Reply to ABHIK DE 4 years ago

VIDE IRDA CODE FOR CORPORATE AGENT INFACT/REGULATION 9(1) OF IRDA REGULATION,2002 CODE OF CONDUCT FOR CORPORATE AGENTS.CAN TNE SAME BROKER OF BANK ASSURANCE SELL POLICIES,WHEN EXISTING POLICIES IN LAPSED STATE,BEFORE LOCKING PERIOD IS OVER?I.E.AFTER PAYING 2PREMIUMS/IN 2009.MIS-SOLD 5 NEW ULIPS,WHEN EXISTING 4 POLICIES WERE IN LAPSED STATE,WHICH SHOULD HAVE BEEN REVIVED FIRST.DONE ONLY TO EARN REVENUE,INCONNIVANCE BETWIN THE BANK AND THE INSURER.CLASSICAL MIS-SELLING.

Sensex, Nifty may see more gains: Tuesday Closing Report

A close above 5,635 on the Nifty will be the first sign that the downturn may be over. A close above 5,700 may give a strong push to the upmove
 

The Indian market pared its gains in late trade on selling pressure from power, consumer durables and healthcare stocks. A close above 5,635 on the Nifty will be the first sign that the downturn may be over. A close above 5,700 may give a strong push to the upmove. The National Stock Exchange (NSE) reported a higher volume of 70.38 crore shares and advance-decline ratio of 554:814.

 

The domestic market opened marginally higher as cautiousness prevailed about growth concerns in China as the country’s central bank said it will refrain from injecting fresh funds into the system despite the prevailing credit squeeze. The development saw markets in Asia in the negative in morning trade. Overnight, US markets fell over 1% on worries of the Federal Reserve tapering its bond buying programme later this year.

 

The Nifty opened 17 points up at 5,607 and the Sensex resumed trade at 18,602, up 61 points over its previous close.  Intense volatility saw the benchmarks hover on both sides of their previous closing levels in morning trade. The market touched its low in the first hour trade. The Nifty fell to 5,570 and the Sensex slipped to 18,487 at their respective lows.

 

The market gained momentum in late morning trade on support from oil & gas, realty, banking, PSU and capital goods shares. Positive stock-specific news and a firm opening of the European markets also added the recovery.

 

Reports of the completion of the merger of Mahindra Satyam into Tech Mahindra, the Supreme Court rejecting a PIL against Ranbaxy and the ONGC arm OVL-OIL combine deciding to acquire Videocon’s stake in a Mozambique block saw these stocks gaining in trade today.

 

The gains expanded in the post-noon session enabling the market hit its intraday high. The Nifty rose to 5,666 and the Sensex climbed to 18,802 at their respective highs.

 

The market pared a major part of its gains in late trade on selling in power, IT and healthcare sectors but managed to end in the green. The Nifty settled 19 points (0.34%) higher at 5,609 and the Sensex gained 88 points (0.48%) to 18,629.

 

Markets across Asia recovered from early losses but most indices settled lower as the overnight interbank interest rates in China fell for a third day, the longest run of declines in a month on the Chinese central bank’s decision to refrain from taking steps to ease the liquidity crunch.

 

The Shanghai Composite fell 0.19%; the Jakarta Composite declined 0.24%; the KLSE Composite retreated 0.55%; the Nikkei 225 contracted 0.72%; the Seoul Composite dropped 1.02% and the Taiwan Weighted tanked 1.22%. Among the gainers, the Hang Seng rose 0.21% and the Straits Times gained 0.51%.

 

At the time of writing, the key European indices were up between 0.90% and 1.55% and the US stock futures were trading in the green.

 

Back home, foreign institutional investors were net sellers of stocks totalling Rs1,552.98 crore on Monday, while domestic institutional investors wee net buyers of equities amounting to Rs931.11 crore.

User

COMMENTS

snehakamath

4 years ago

This is the time for investraders.
The markets have substantially corrected , little more can further correct. However this can be start point for investing.

Large cap shares which have been beaten but with good management and reasonably good results are available at really attractive prices.

If the market corrects a little more one can continue to hold these blue chips. If however in short term there is sudden spur in the market one can change colors as traders from Investors ( hence investraders) , As under current situation you will again get another opportunity to buy them.

Good Luck

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