IRDA yet to disclose claims repudiation ratio for 2009-10

IRDA has not disclosed details of repudiation of claims for 2009-10 for reasons best known to it. Private life insurers have come out pretty badly vis-à-vis LIC in this regard
 

Claims experience has to be one of the most important factors to consider before finalising life insurers, because every insurer will love to collect premiums, but few insurers will feel the same about claim payments.
 

Unfortunately, this crucial data is not available for 2009-10. LIC comes out better than private insurers in this regard. It too does not disclose its repudiation number for 2009-10, but hinted that it was slightly higher than 1.33% which was the figure in 2008-09. Looking at the atrocious claims repudiations percentage of private insurers, they may be the ones having something to hide. Can the Insurance Regulatory and Development Authority (IRDA) publish the numbers soon?
 

Based on 2008-09 data, the most incredible statistic is that of Aegon Religare with no claims settled, 71.43% claims repudiated and 28.57% claims pending. Please see: www.docstoc.com/docs/58633842/IRDA-claims-settlement-08-09.

It could be that for 2008-09 there were lesser claims being generated because of new business, and unfortunately, the claims that came in had to be genuinely repudiated. We have to give the benefit of the doubt if that is the reason. When a life insurance company gets a claim within three years of policy start there is always investigation and possibility of claim repudiation.
 

Bharti Axa Life has recently unveiled its new brand positioning - "Jeevan Suraksha Ka Naya Nazariya." It has a service guarantee of "Release of Fund Value within 48 hours" of receiving claim intimation. It is even advertised on TV. In 2008-09, Bharti AXA Life had 53.20% claims settled, 44.83% claims repudiated and 1.97% pending. Low claims pending shows that Bharti Axa certainly is making quick decisions on claims, but high claims repudiation means that one out of two claimants will never get claims paid, forget about the 48-hour claims settlement.  We will again give the benefit of the doubt to this insurer if the 2008-09 data is indeed skewed due to new business.
 

The reason for repudiation can be due to incorrect/hidden details in policy forms filled by a policyholder with or without abetment from an agent. It is imperative that the policyholder fills up the policy form completely and in good faith without the agent filling any policyholder personal data. An ethical agent who is properly trained by the insurer will not mislead the potential customer just for getting commission. The policyholder will be at a loss because the policy form will be scrutinised only at the time of claim.
 

The other reason can be policyholders themselves indulging in fraud. As far as fraudulent claims are concerned, the insurer has every right to repudiate the claim.
 

According to Vipin Anand, chief-corporate communications, LIC, "Repudiation of claims also has investigation cost and possibly litigation cost in cases of a policyholder filing a grievance. In some cases, these costs can be greater than the claims cost. LIC can repudiate claims on technicalities and policy wording, but it does not do so unless there is a fraudulent claim. Moreover, LIC is in a strong financial position and does not worry about the bottom-line when genuine claims have to be paid. We pay on (an) average 77,000 claims in a day. "
 

Private insurers are struggling to break even and will surely be scrutinising claims to a greater extent. It will be hard for them to keep up with the giant called LIC. When will private players measure up to the insurance behemoth?

Comments
K B Patil
2 decades ago
I was not looking at insurance companies closely. The data (claims repudiation) is horrifying. Are these guys fly by night operators or what? In India, service is still a dream for most people. The agent is there only till the policy is purchased and then fades into the background. Likewise, in case of doctors and lawyers, they treat their clients like the priests in all the big temples in India. You stand before them as supplicants, not as one who is paying money and is on a equal footing in a commercial relationship.
Amalaraj Marian
Replied to K B Patil comment 2 decades ago
Mr. Patil Your fear is what i was talking about lom at my other feedbacks
Manu
2 decades ago
Till date there is no subtitute of LICI.
LIC of India know Indian better.Peoples of india love Lici and the agents of Lici.
Plz.Indians LOVE LOVE Lic of India.
Yogesh
Replied to Manu comment 2 decades ago
Manu , You are right.Indians LOVE BONUS,They prefer less life cover,they don't want transparency,liquidity,flexibility.They like to revive policies if they forget to pay premiums,Indians don't want choice of different funds in their investments,They like to to take loan of their own investments and pay interest thereof,They like terminal bonus,
They want JEEVAN with ANAND.
WHY GO ANYWHERE ELSE ? WHEN THERE IS LIC.
PEOPLE GET WHAT THEY DESERVE.
Amalaraj Marian
Replied to Yogesh comment 2 decades ago
Kudos Mr Yogesh you said it all.
If you mis-sell in crores the %age which one is talking of will look small on any data analysis. But the actual number will run to several thousands. The gaint is doling out choclates icecreams and golas to connect to the small minded masses probably they understand that. but the big boys make money else where and that is surely not any of the life insurance companies. these companies are here to swindle people. The industry is consolidating times will come when the entire skeletons will fall out of the cupboards.
balaji
Replied to Amalaraj Marian comment 2 decades ago
What else want the people to do put their mony in the stoct market and related things and get heart attack when ever the market goes down.The amout of knowledge our people have atlest the endowment will give some peace of mind and not hear attack.
Yogesh
Replied to balaji comment 2 decades ago
Indeed endowment plans will not give heart attack but it will give heartache,heartbreak and heartburn.Balaji from the long term point of view which is a better asset class?.Which endowment plan has given double digit return till date?Equity as an asset class is the best and investments in endowment plans are mostly in debts and "socially oriented sectors".
balaji
Replied to Yogesh comment 2 decades ago
I dont deny,but the poeplie are knowlegble enough to be pushed in to any thing linked to share market that is my piont.Not all the people are as knowlegable as you and tell me one thing has anybody who is involved in stock market scams has ever been punished?
Yogesh
Replied to balaji comment 2 decades ago
In spite of weak PMs,outside support govts.scams of Harshad Mehta,Ketan Parekh,UTI etc.etc."DIVERSIFIED EQUITY" portfolio have delivered handsome returns.Schemes like Mastershare,Reliance growth,Franklin Templeton Blue Chip,HDFC equity etc.. have really helped wealth creation process for small investors.Compare this with returns of "traditional" policies.The same will hold true for ULIPs in the long run.
Amalaraj Marian
Replied to balaji comment 2 decades ago
Dear Mr Balaji,
I am not contesting on your fears. What i want you to do is to take a rationalised view. If one is quilified formanagement job will he then work as a clerk? Same why your money has a capacity to earn for you in mulitples then why do you want to strifle the growth of this power of the money. Whatever your apprehension are there about the stock markets may be true. but the fact remains is here no one is forcing you to go to the markets directly. what one is saying is you need to do investments thru mutual funds where there are proffessional managers who invest your money in the markets with more knowledge than you and i can do normally. Since they are there close to the markets they have all the informations as to what would be happening from now and the investments are more knowledge based and research driven then sentiment driven. Hence there is a better return generated with less amount of risk taken.
you want to know more about this mr balaji i would welcome you to a detailed discussion (you could call me 9822004673) if possible or you could send me a mail at [email protected] i will show you how you could make more money sensibly then to take a stand where in there is only one way to go underperformance and a sure loss in the long run.
Yogesh
Replied to Amalaraj Marian comment 2 decades ago
You are right skeletons have started falling in LIC.The secretary of investments dept. of LIC[equivalent to CIO of asset management company] has been arrested for fraud .Media has concentrated on only on LIC Hsg. Finance.LIC is the only organization where there is no TRANSPARENCY with regards to investments and this according to me is only tip of the iceberg.There are many Niira Radias at work for LIC so nobody will question LIC about its investments etc..In media questioning LIC is like act of TREASON.
TRUST THY NAME IS LIC.
Amalaraj Marian
Replied to Yogesh comment 2 decades ago
Dear Yogesh, I feel vendicated, its not just this there will be more because the entire insurance industry is not regulated and the investments that are done by them are not as transperent as they should be. Specially in the unitlinked area the space is absolutely grey there will be a time when the kind of stuff that will come out will be shocking.
More over there are other products in the LIC which have guranttees viz the jeeven shrees the guranttee is even today not acheivable. so the other policy holders will be paid less to meet these commitments who ever buys now will surely feel cheated in the years to come.
sanjay shah
2 decades ago
I THINK IRDA HAS NOT PERFORM THEIR DUTIES WELL, BECAUSE AT THE TIME OF APPROVAL OF ULIP PLANS OF PVT.LIFE COS. HOW THEY HAVE ALLOWED ALLOCATION CHARGES FROM 40% TO 80%. IN CASE OF HDFC STD LIFE GUARANTEED HIGEST NAV PLAN FOR 1LAC PREMIUM TOTAL CHGS IS APPROX.10000/- & AGENT COMM.IS 12000/- HOW CO IS ADJUSTING SUCH EXP.? IRDA MUST PUBLISH IN ALL LEADING NEWS PAPERS CLAIM O/S & DENIED FIG. SO THE MASS CAN KNOW WHICH CO.THEY SHOULD SELECT FOR THIER PRECIOUS LIFE.
arvind
2 decades ago
lic is big daddy ,jai ho.......
amalaraj marian
Replied to arvind comment 2 decades ago
Even Priemier (doshis) and Hindustan Motors(birllas) were living in such a fools world till maruti came and changed the ball game. the bigger they are the harder they fall..........watch out
Deepak R Khemani
Replied to amalaraj marian comment 2 decades ago
Mr Amalaraj probably has something against LIC due to his unfortunate experience in dealing with certain officials and staff of LIC. For him to compare LIC with Hind Motors and Premier seems foolish. For his information LIC's market share in the last quarter has increased tremendously and is going to do so in the future also as the new ULIP guidelines have hit the Private insurance companies hard where they have had to close down a number of branches and lay off Staff to save on costs.
LIC JAI HO
Amalaraj Marian
Replied to Deepak R Khemani comment 2 decades ago
What more evidences do you need mr khemeni you also seem to be the part of the whole bunch of leaches who thrive on the aam asdmi money. and use the money for growing big. If this is not the case you will not defend it tooth and nail. LIC has used peoples money to dole out the goodies to the officers and the agents of the corporation. while the poor policy holders were paid peanuts. You all used peoples money at trival interest rates to by the goodies like cars while the same corporation loans to the policy holders at rates far above the bonus rates if you want more of this i can come out with a lot more but just like what the great wisidom says when you walk on the road you dont throw stones at every dog that barks you might as well carry some biscuts samje
Deepak R khemani
Replied to Amalaraj Marian comment 2 decades ago
With the kind of reply you have posted Mr Amalaraj it shows the mentality you are working under. Always remember that when you point a finger at others 4 are pointing back at you. I have never called you any names but you on your part are hell bent on calling people leaches and what not without even knowing me or anyone else who have posted their honest views on this article.
All those who call others dogs should remember that they should not bark.
amalaraj marian
Replied to Deepak R khemani comment 2 decades ago
I don't wish to create any bad blood but the facts are facts and these are not said without any truths if any of the facts mentioned by me are not what are not happening in a mass scale with the corporation then you should not have been so worked up. the very fact is that the officials are there in so many instances tht i have mentioned. and that to very senior. i have nothing personal with you but i would be very critical if you are misusing peoples money. here on i dont wish to reply to you feed back i have bared the truth more than what could have been expected
Deepak R khemani
Replied to amalaraj marian comment 2 decades ago
Please read this article(Private insurers are not even snapping at LIC’s heels) posted on moneylife and you will understand what was the point I was trying to get across.
Madhusudan Thakkar
2 decades ago
The claim repudiation will increase in the months and years ahead especially because we now have policies sold "online only".It is very difficult for insurance company to determine life assured health,habits, income etc... correctly.In the policies sold through distribution network there is at least a moral hazard report to be filled by different persons depending on sum assured after verifying above details. One more reason of repudiation is "Sales force" are not properly trained by Insurance companies on this vital aspect.
Deepak R Khemani
Replied to Madhusudan Thakkar comment 2 decades ago
Agree 100% with what you have said.
All those who fall for low premium Policies available online only(without the services of a trusted advisor, prompted by what they read in financial journals and watch on business channels), their families/dependents may have to repent later because in case of repudiation of claim, the whole purpose of having a policy whose monies would be payable to your dependents in your absence would be defeated and since there is no agent/ advisor involved do they expect the company officials to come to their house to settle claims? This repudiation ratio is bound to increase. ALWAYS BUY YOUR POLICY FROM A TRUSTED FRIEND/ASSOCIATE/FAMILY ADVISOR WHO IS PROPERLY TRAINED AND HAS A FEW YEARS EXPERIENCE IN THE FIELD OF INSURANCE SELLING
Amalaraj Marian
2 decades ago
I personally feel people seem to jump the gun on this issue. The fact is that unless all the facts are laid clear on the table it is too early to say anything.If the case is so then the IRDA is more responsible to see that the ratio is maintained well within the required percentage. The important fact is that if there are early claims only in that case the company may go into investigation or else the company will have to go and pay the claim. The role of the agency force is very important here and they need to know that the commission amount is very small compared to the loss the policy holder has to face. with the numbers at play now the chances are that a lot of things are not comming out very clear, or else the track of LIC is also very much doubtfull. I can say this because there is a clear case of undue delay in settling claims. The agency force is least interested in helping the claimant. I have a genuine case where the agent just didnt bother to service the death claim and he just dropped the forms at the claimants place and went away saying you fill the forms and submit them to the office i have spoken with the concerned people there. Then the office took more than 9 Months to settle the claim at also the claimant was called to the office to collect the cheque. The cheque was not ready and there were three people from the clerk to the accountand and the divisional manager preasurising the lady to buy a new policy saying that what was not going to come to you why should you not put the same in some other policy? Sic!!!!! all this for the punch line Jindigi ke saath bhi aur jindigi ke baad bhi........
Lets come out and talk about what is the right of the policy holder then telling whose clothes are the whitest.
Deepak R Khemani
Replied to Amalaraj Marian comment 2 decades ago
IRDA has nothing to do as far claim repudiation ratio is concerned except to publish the figures. IRDA cannot get the companies to pass the claims favorably.
Those who say that the track record of LIC is doubtful should first check the claims ratio of LIC before making such a statement.
The case of the agent mentioned by you should be brought to the notice of LIC as well as others in your family and friends circle so that he does not get any business from your friends and family. LIC has a dedicated CUSTOMER RELATIONS CELL where any delay beyond a reasonable time should be reported immediately to get the claim settled as soon as possible.
If all your papers are in order then there is no reason that the claim will be delayed.
The case mentioned by you makes it all the more clear that you should buy your LIC Policy from a trusted friend/ associate/ family advisor who can help you in times of claims where followup with LIC is required.
Amalaraj Marian
Replied to Deepak R Khemani comment 2 decades ago
Mr Khemani you have not read the write up clearly i suppose there are three LIC officials i mentioned. this includes the Divisional Manager who was so arrogent and hell bent to sell one more policy to the widow of the policy holder sic!!!! you call this service? this is leaching on to the aam aadmi and suck away the blood this man was not aware of the rights of a policy holder. Gross violation on his behalf so according to you such a person should not be given business that is what your note mentions. Similarly the LIC agents are there after you only till the policy is sold after that they just vanish. There are the big names also in this. I will quote an agents words "Aaj Policy beech do premium tu client ko Ghxxx marke bharega. And all this guys who come promissing great things dont come with the caption written on their forehead that he is going to ditch you when you will need you the most. The LIC employees are themselves so arrogant when one has to visit the offices for small activities which should have been done by the agent. it is just unbareable there should be a provision of answerability for such erring agents and officials.
Deepak R khemani
Replied to Amalaraj Marian comment 2 decades ago
Obviously dear Amalaraj sir you have not read my reply. I have clearly stated that you should not give business to the type of agents you have unfortunately dealt with.
I said Buy your policy from your TRUSTED FRIEND/ASSOCIATE/ FAMILY ADVISOR who will not only sell you the right policy after analysing your needs but will also be there when his services are required. Obviusly you have had a bad experience will certain LIC branches/ officials/staff. I have also mentioned in my reply that there is a grievance redressal cell/ customer relations cell which needs to be approached in case of any complaints or delays.
I hope you get the point of what I am trying to say.
vivek
Replied to Amalaraj Marian comment 2 decades ago
Marian, read the stuff and then reply... and stop writing crap.... looks like you dont have any work... are you a lawyer ???
amalaraj Marian
Replied to vivek comment 2 decades ago
Mr Vivek Such hamesha kadwa hota hai the truth is this has happened in reality. So there is no doubt about the fact that indead there are people who resort to mis selling and working to their needs then the customers need. For your information I am also a finance Professional so you now know who you are talking to.
S VIVEK
2 decades ago
IRDA was always publishing things relevant for a customer late and does not advertise what data and where it is published.In many instances both agent and customer are at fault.
Madhusudan Thakkar
2 decades ago
No one can dispute that in claim settlement ratio of LIC is best in the world.But I have one more point on this issue on ULIP claims.In these products when claim is repudiated nothing is paid to the nominee of policyholder.These products deduct mortality charge on the basis of life assured age and health plus there is an investment component If policy holder dies the nominee is paid either sum assured or fund value WHICH EVER IS HIGH.Now when claim is repudiated the nominee is NOT PAID ANYTHING.WHY FUND VALUE SHOULD NOT BE PAID TO THE NOMINEE IN CASE OF REPUDIATION OF CLAIM? In ULIP sold by UTI since 1971 fund value is PAID even in case of repudiation of claim.I strongly feel that media should pursue this matter and IRDA should ensure that even in case of repudiation nominees are not denied fund value.
Deepak R Khemani
Replied to Madhusudan Thakkar comment 2 decades ago
There are 2 types of ULIPs involved over here. First is the one you mentioned where in case of death either the sum assured or unit value is payable whichever is higher. There is another type of ULIP in which Sum Assured PLUS unit value is payable in case of death.
UTI Ulip also now has a facility of constant life cover till the policy is in force wherein the sum assured plus unit value will be payable in case of death. The other option mentioned by you is also available
Madhusudan Thakkar
Replied to Deepak R Khemani comment 2 decades ago
Deepak Ji you are right that there are 2 types of ULIPs,But 90% of ULIPs have only one option i.e Sum assured or Fund value which ever is higher.My only contention is why "FUND VALUE" should not be paid even in case of repudiation of death claim? Especially because of transparent nature of these plans.Fund value is an investment portion at any given time during the tenure of policy and it has nothing to do with "risk cover". This feature of "ENTIRE REPUDIATION" of claim is totally arbitrary,inconsistent and irrational.
Deepak R Khemani
2 decades ago
As far as Life Insurance is concerned it makes sense to stay with the Big Daddy LIC as can be seen from the claims ratio of 2008-2009.
The claims ratio of private companies is going to be no better for 2009-2010.
When you take an Insurance policy on your life, what is the point in taking a Policy with a lower premium but having chances of it being repudiated, After all you are taking the policy for your family who can get a lump sum in case of an unfortunate event, what if your family does not get the amount, Who will look after them ?
Will it be the Online portal which offered you a mouthwatering low premium or an agent of a private Insurance Company who may never turn up after he gets the first premium from you as he may have changed his association with a few life insurance companies in a few years time. I personally know quite a few agents who have been associated with different life Insurance companies in the few years of their life Insurance Agency, and with the new ULIP guidelines coming into force, a lot of Insurance agents(advisors) especially from the private Companies have been forced to look for other jobs.
Great Job Moneylife for publishing such an article. Keep up the good work.
R Balakrishnan
2 decades ago
I would look for private insurers with high claim repudiation and bet on them in the IPO stage. In the long run of course, those companies will have to close down as people realise that the co does not settle. But it will be a long time. Please keep publishing these statistics.
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