The claims settlement ratio for Max New York Life (MNYL) has fallen from 90% (2008-09) to 65% (2009-10). As usual, LIC is the topper. Look out for key ratios of claims settlement, repudiation and pending cases before buying insurance

The claims settlement ratio for Max New York Life (MNYL) has fallen from 90% (2008-09) to 65% (2009-10). The 'claims settlement ratio' is the number of claims settled with respect to claims received.

MNYL has settled 3,943 claims out of the 6,019 claims it had received in 2009-10.

The 'claims repudiated ratio' is the number of claims rejected with respect to claims received. MNYL has rejected 12% claims (741 out of 6,019). The 'claims pending ratio' is the number of claims pending (not settled, nor rejected) with respect to claims received. MNYL has 22% pending claims (1,335 out of 6,019).

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. 

MNYL started its operations in 2000 and hence should have a better claims settlement ratio as well as lower claims repudiation and pending ratios. However, this was not the case for 2009-10 data, when compared to the data for 2008-09.

Moneylife emailed the corporate communications department of MNYL last week to get a clarification, but we have not received a reply from them. MNYL has a mix of traditional and ULIP (unit-linked insurance plans) products. It has a ULIP child plan and recently came out with a traditional child plan. But if a settlement problem arises for death claims, how can a policyholder's child be ensured higher education or cash flow in absence of her earning parent?

The Insurance Regulatory and Development Authority (IRDA) has sent a warning letter to MNYL. The letter dated 24 January 2011 mentions that the insurer admittedly defaulted on non-payment of penal interest for claims settled beyond six months and repudiation/investigation of claims beyond six months.

IRDA has noted that the insurer has largely attributed the above default to process infirmities and inadequate quality of resources. IRDA has also noted that the insurer has reviewed all cases beyond six months and paid the penal interest admissible. MNYL has put a process in place to ensure that penal interest is paid as a rule in respect of cases where admitted beyond six months and investigations/repudiations are completed within six months without fail.


IRDA -

Can IRDA publish claims settlement, repudiation and pending ratios sooner every year? The 2009-10 data came out in end-December 2010. It will also help if the regulator puts out this important data in public eyes by publishing it in leading newspapers/magazines, rather than keeping it in a 526-page report that the public may not even bother to read-let alone understand it.

Instead of ULIPs 'ke chaar sutra' published in newspapers that carry not-so-great information for readers, why not highlight all the warnings and penalties levied by IRDA in newspaper/magazine advertisements? This will also deter insurance companies from committing any lapses. An insurance company repudiating a legitimate claim is a severe financial blow to the surviving family.

Please read 'IRDA yet to disclose claims repudiation ratio for 2009-10 '

Claims settlement, repudiation and pending ratios are important factors to be considered before buying insurance. These ratios have to be looked at from the viewpoint that life insurance companies that were started recently are bound to have lower settlement and higher pending claims.

This is because any death claim that happens within three years of policy issuance gets scrutinised for its veracity. It can take time for claim settlement and there is even a possibility of claim repudiation. The longer an insurance company has been in existence, the ratios should start looking favourable for the entity.

Insurance company inefficiencies or poor underwriting practices can be a reason for high repudiation ratios. It can also 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.

Insurance companies launched since 2007 have less than 50% claims settled except Star Union Dai-ichi (59%) and IndiaFirst (54%).

Future Generali (launched in 2007) had claims settlement ratio of 57% in 2008-09 and is down to 39% in 2009-10. The claims repudiation is almost the same in both the year groups (30%). The claims pending have increased from 13% in 2008-09 to 31% in 2009-10. It is typical of life insurance companies which have recently (2007 or later) entered the market getting hit by claims and taking their time to settle claims, due to the need for verification of authenticity of claims.

Bharti AXA Life unveiled its new brand positioning last year - "Jeevan Suraksha Ka Naya Nazariya." It has a service guarantee of "Release of Fund Value within 48 hours" of receiving claim intimation. The settlement promise is only applicable for unit-linked insurance plans (ULIPs) and not for any other insurance plan including term insurance. The promise is to settle only the fund value of the plan and not the sum assured. In 2009-10, Bharti AXA Life had 77.80% claims settled, 22.20% claims repudiated and 0% pending. Zero pending shows that Bharti AXA certainly is making quick decisions on claims.  

Shriram Life launched its operation in the year 2005, but its claim settlement for the year 2009-10 has been only 40%, claims repudiation is 20% and claims pending stands at 40%.

Tata AIG launched in 2001 still does not match its peers in claims settlement, repudiation and pending ratios even with the name of the biggest business group in India attached to it.

Private insurers are struggling to break even. With new ULIP regulations driving business away from ULIPs to traditional plans as well as lowering of new business premium collection in crucial months for tax-savings, insurance companies will surely scrutinise claims to a greater extent in the future.

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