Now, general insurers hire panels of doctors on their rolls
12 May, 2014 01:01 PM
Health insurance, which has an almost 23% market share in the general insurance space, has seen the increased claims ratio touch 96.43% in FY13, as compared to 94% in FY12.

General insurance companies are now hiring entire teams of doctors to not only help customers who require a second opinion in case of some ailments, but also for their underwriting and claim-redressal processes.

While earlier, only a few companies used to have a small team of two to three doctors, insurers are now looking at bigger panels to be employed with them.

Health insurance, which has an almost 23 per cent market share in the general insurance space, has seen the increased claims ratio touch 96.43 per cent in FY13, as compared to 94 per cent in FY12.

While for public sector general insurers, the incurred claims are still less than 100 per cent, private sector general insurers have seen it cross 100 per cent. This means that the claims incurred are more than the premiums paid for such private general insurers.

To deal with this situation, both public and private players are taking active steps to reduce losses in this segment.

“Earlier, some players in the non-life industry would have one to three doctors on their roll who would perform basic underwriting functions to check if a person was too risky to be insured or not. Now, more than 4-5 doctors are being employed by each company, not just for underwriting, but for claims verification as well,” said the general manager of a public general insurer.

The largest general insurer, New India Assurance, a public sector entity, is planning to have a total of 50 doctors on its rolls. It already has 25 and would look to hire another 25 this fiscal.

G Srinivasan, chairman and
director of the company had said that this would enable them to manage claims in a better manner and also look into the third party administrators' space.

New India is not alone. Private companies like Future Generali India Insurance also have doctors on their rolls, albeit a smaller number. K G Krishnamoorthy Rao, managing director & chief executive officer of Future Generali India Insurance said that they had six doctors who not only assisted them in the underwriting process to ascertain the type of risks that were accepted by the company, but also worked with the insurer in the claims process.

Even newer companies have made it a part of their strategy. Sandeep Patel, chief executive officer and managing director, CignaTTK Health Insurance had earlier said that the company would have doctors on board to help customers. CignaTTK is aiming to offer differentiated health insurance solutions, including health and wellness programmes that support customers in making lifestyle changes and managing chronic medical conditions.

Sanjay Datta, head of underwriting and claims at ICICI Lombard General Insurance said that their doctors not only assisted the company in claims processing, they also helped in case a patient needed a second opinion.

Apart from basic functions, in cases where there was a doubt in the insurer's mind about the veracity of the claim, the doctor would be at his disposal.

“There have been cases where an insured person gets a particular treatment done in a hospital and claims for it, even if a surgery may not have been required. If there are some discrepancies in their claim size or type, we take the help of our in-house doctor who advises us as to whether this procedure was unwarranted,” said a senior executive of a private general insurance company.

To prevent these anomalies, Insurance Regulatory and Development Authority regulations have called for standardisation in health insurance.

This would lead to quicker settlement of claims and reduce claim and policy-related issues, said insurers. Further, they have undertaken a project through the Insurance Information Bureau of India, to have a health directory where detailed information about the various medical procedures and cost in different hospitals would be provided.
Source : Business Standard

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