While CIC’s directive to United India to put the date of the policy renewal and the date of policy dispatch to the TPA for every policy is welcome, it has not disclosed everything
The sweet victory for Dr Anshu Agrawal was that Central Information Commission (CIC) took the liberty of looking at the issue in the larger public interest of the insurance policyholders and not just confined to the United India Insurance Company's (UIIC) Bareilly office. The CIC recommended to the chairman and managing director of United India to give directions to all branch managers to put up on the company's website the following information by 16 August 2012: Mediclaim policy number (no names are required to be given), policy date of issue, date of transfer of the said policy to the TPA (Third Party Administrator).
While the option to give past data is left with UIIC, it is unlikely they will give historical data. Giving the information for present and future policy purchases and renewals will mean that the UIIC will have to improve its processes to really live up to its own answer of 'immediately' sending of policy data to the TPA.
One year ago Dr Agrawal had filed a Right to Information (RTI) application seeking UIIC answers. The answer to the question on how many days it takes for a health policy to be dispatched by UIIC to TPA was unbelievably-'immediately'. Obviously, UIIC Chief Public Information Officer (CPIO) did not want to give any specific number of days, which would have been an embarrassment for them. Dr Agrawal was obviously not satisfied with the term 'immediately' which did not give specific answer.
UIIC was blatant enough to agree in the RTI reply that cashless and reimbursement claim will be denied if the TPA does not have policy renewal data. If it takes two to three months for the policy purchase or renewal data to reach the TPA and/or TPA does not update his system, why should the insured pay the price of cashless or reimbursement claim denial? It is a shame if insured is paying for inexplicable inefficiencies of the insurer and/or the TPA.
On the question of data for mediclaim issue date and policy dispatch date for mediclaim policies purchased or renewed by the Bareilly branch office, UIIC CPIO refused to divulge the data in the RTI answer by stating that the information is under fiduciary relationship and is not in larger public interest.
Finally, in the second appeal, the CIC directed UIIC to give information on the total number of mediclaim policies issued by the Bareilly office that were dispatched to the TPA after one week of the date of issue. Even after a specific directive from the CIC, UIIC CPIO has dared to defy it by giving irrelevant data of 297 mediclaim policies issued by the Bareilly office in 2010-11, out of which 293 policies have been sent to the TPA. Can the UIIC CPIO not read that CIC judgement that data on policies that were dispatched to the TPA after one week of the date of issue should be disclosed?
Stay tuned for the third part of the article which you will be interested to know of a little known 'behind the scenes' dealing between UIIC and TPA.
Read first part of the article CIC asks United India Insurance to disclose information that may help close a loophole - I
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