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United India continues to reject insurance claims

23 November, 2011

Its business as usual even after two months of the IRDA circular which asked insurers to not reject claims on technical grounds. With no warning or penalty for specific insurers, will the IRDA circular be taken seriously?

Two months ago the Insurance Regulatory and Development Authority (IRDA) issued a circular to life and non-life companies asking them not to reject claims on technical grounds like a delay in filing. Some insurers including United India Insurance were rejecting claims mechanically based on delay in hospitalisation intimation and claims filing. Claims continue to get rejected even after IRDA circular.

For starters, there is no warning or penalty for insurance company to reject claims mechanically on grounds of late filing. The IRDA circular is not an 'order' directing any particular insurance company to strictly adhere to the claims rejection on technical grounds. By not naming the errant insurers, the companies can feign ignorance of the snag happening under their nose.

According to industry sources, "The end result is that there is no directive given by insurers like United India to its regional/division offices or third-party administrators (TPA) to take necessary remedial action. There is no change at the ground level which makes the IRDA circular completely ineffective." Another source confirms that there is no relaxation on the strict deadlines and condone requests will be rejected in most cases.

United India has strict deadline of hospitalisation intimation within 24 hours and claims submission with seven days of hospital discharge. Minor delay results in claims rejection and condone request is usually refused. Moneylife has examples of some claims rejection even when the strict deadlines were met. Moneylife has done cover story (3 November 2011) on 'Insurance Claim Rejected'

Interestingly, United India is the only government-owned general insurer which has shown profits and has aggressive plans for business growth. The company's CMD was quoted saying they have premium target of Rs8,000 crore this year at 25% growth rate in business. They plan to bring down underwriting losses- premium less claims outgo - to Rs900 crore from last year's figure of Rs1,760 crore. He adds, "Better underwriting, proper pricing of group policies, tightening of claims procedures in respect of health insurance and audit of claims settling agents resulted in reduction in health claims outgo." The 'tightening of claims procedure' surely includes claims mechanically rejected on flimsy grounds of any minor delay (or no delay in some cases) in hospitalisation intimation or claims submission. It did not matter that the company happily collected premiums from same customer for decades.

According to one Moneylife reader, "United India has instructed its offices to send soft data, to the TPAs, of health insurance renewals once a month only, usually on the last day of the month. As a result when an insured is admitted to a hospital a week or two after his policy has been renewed and he contacts the TPA, he is told that as per their records his policy has not been renewed and therefore they are unable to register his claim even though he had called them within the mandatory 24-hour deadline! As a result he is also denied cashless facility and has to go in for reimbursement which again will be denied on the grounds that the claim was not reported within 24 hours!"

He adds, "Another ploy being perpetrated on the policy holders is the raising of queries pertaining to the claim by the TPA wherein it is stated that if the insured does not respond within 15 days the file will be closed. This communication in most cases is not posted to the policy holder whereas a copy of the same is kept in the insured claim file. In cases where it has been despatched the letter usually arrives just a day or two before the deadline giving the insured no chance to reply in time. Once the file has been closed, only a letter from the regional manager will be accepted to reopen the file. The branch (division) mangers have no say on this issue! But if an insured has the tenacity to fight his claim will no doubt be settled. United India is fully aware that a lot of policy holders will not go that far and will simply bemoan their fate and this is United India's way of trying to keep claim ratios within tolerable limits! Policyholders are warned!"

There is no initiative from IRDA to monitor the ground reality of mechanical claims rejection. Will IRDA get the statistics on claims rejection and reasons given by insured for delay? Will it do an analysis on how many requests to condone delay were approved and rejected? Does IRDA intend that insurer follow its advice from the date of circular? What about the claims which are already rejected and condone requested? What about claims which are already rejected, condone rejected and cases closed? The mechanical rejection has been going for long time and the relief has to be applicable for past cases, too. Will IRDA review such cases and give justice?

IRDA needs to check if the insurance company and TPA have a 24X7 system in place to receive intimation and give confirmation number. They should insist on such system being 24X7 customer care and not force the insured to send fax or email within 24 hours of hospitalization. Fax and email for hospitalisation intimation are disputed as being not received or not legible. It is a perfect excuse for claims rejection.

Why Car Insurance is important for you.

Peace of Mind

Knowing that you are protected financially in case of an accident can reduce stress and allow you to focus on safe driving practices

Financial Protection

Car insurance provides crucial financial protection in the event of an accident. Without insurance, you could be liable for paying for the damages and medical expenses out of your pocket

Legal Compliance

Driving without insurance can lead to severe penalties, including fines, license suspension, or even legal action

Coverage for Third-Party Liability

Liability coverage in car insurance helps protect you from the financial repercussions of such incidents

Coverage for Theft

Comprehensive insurance coverage can protect you against the loss of your vehicle due to theft or damages caused by vandals.

Protecting Your Investment

A car is a significant investment, and having insurance ensures that you protect this asset from unexpected damages and financial losses.

Don’t forget these handy tips while renewing your car insurance policy:

  • Compare, compare, compare! Check out multiple insurers, policies, and premiums before deciding.
  • Keep your policy number and details handy for a smooth renewal process.
  • Grab those discounts and offers! Being part of the Automobile Association of India can score you some sweet discounts (up to Rs. 200) on OD premium.
  • Don’t miss out on that No Claim Bonus (NCB) if you’ve been claim-free. It’s like a reward for your careful driving!
  • Consider add-ons that suit your needs, like engine protection, glass cover, and more.
  • No Claim Bonus, which can save you some serious cash in the long run.

What is included and excluded in Royal Sundaram's car insurance policy?

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Accidents

Car insurance is your safety net in accidents and collisions. It covers damages and losses, ensuring you don’t bear the financial burden alone

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Third Party Losses

Oops, accidents happen! But don’t worry, car insurance has your back if your car causes damages to others vehicles or property. Drive stress-free!

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Fire

Stay worry-free! If your car faces accidental fire damage, insurance has your back. Get quick support and coverage to get back on the road!

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Natural disaster

No need to stress about natural calamities! With insurance, your car is protected from flood, cyclone, and other damages.

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Personal accident

Your well-being matters! In case of an accident-causing death or disability, car insurance offers support, ensuring you and your loved ones are taken care of.

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Theft

Worry less about car theft! Insurance has you covered if your car gets stolen. Get peace of mind knowing you won’t be left stranded.

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Pre-existing damages

Any type of damage that your car has suffered before buying a policy from us will be not covered.

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Illegal driving

Please note that driving drunk or without a valid license will not be covered. Drive responsibly to stay covered and safe on the road.

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Driving without valid documents

Ensure you have all the required documents while driving. Car damage incurred without such documents, like a valid driving license, won’t be covered.

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Add-ons not Bought

Certain situations are covered through add-ons. If not purchased, these situations won’t be covered. Consider add-ons for comprehensive protection.

Crunching the Numbers: The Cost of Car Insurance Policy Renewal

You’ve got options here, folks!

Third-Party Car Insurance:

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VM SUNDARAM

I wanted to take a moment to say thank you for your excellent and quick service. I really appreciate the help you provided, and I'm happy with the work you did for me. It was a tough task for me, but your staff's support made it easier. I've been a member of your insurance company for four years, and I'm glad I chose ROYAL SUNDARAM insurance. Even on the weekend, the claim process went smoothly, and I'm grateful for how your employees communicated with me and approved my request within just one day. Your company's commitment is truly remarkable, and I want to thank you again for your support.

I wanted to take a moment to say thank you for your excellent and quick service. I really appreciate the help you provided, and I'm happy with the work you did for me. It was a tough task for me, but your staff's support made it easier. I've been a member of your insurance company for four years, and I'm glad I chose ROYAL SUNDARAM insurance. Even on the weekend, the claim process went smoothly, and I'm grateful for how your employees communicated with me and approved my request within just one day. Your company's commitment is truly remarkable, and I want to thank you again for your support.

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I want to mention how impressed I am with the quick response from your office. The survey was promptly scheduled and conducted, and the approval was given in a timely manner. I am truly delighted with how you handled my claim. Your explanation and settlement of the claim amount left me satisfied. I never expected such a smooth and efficient process from an insurance company. I am very thankful to you and the management for the support you provided. Your response and handling of the situation were excellent. I am looking forward to renewing my policy with your company and will also recommend others to consider your services. Keep up the good work!

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V SARAVANAKUMAR

In April of last year, I reached out to your company to file an insurance claim for my vehicle, Vitara Breeza. I am delighted to share that Mr. Kalimuthu from your company, Valuor, provided me with full support throughout the process until I received my vehicle. I want to express my heartfelt gratitude to your company for this excellent service. Thank you very much!

In April of last year, I reached out to your company to file an insurance claim for my vehicle, Vitara Breeza. I am delighted to share that Mr. Kalimuthu from your company, Valuor, provided me with full support throughout the process until I received my vehicle. I want to express my heartfelt gratitude to your company for this excellent service. Thank you very much!

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I want to extend my gratitude for helping me with the windshield replacement for my car. Your service was incredibly fast and hassle-free. I truly appreciate the timely assistance, and I'd like to give special thanks to Mr. Kiran for organizing the team. Thank you once again!

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I had a very pleasant and trouble-free experience during the settlement of my claims after a mishap and narrow escape. The surveyor and office executives played a crucial role in making the process smooth, and I highly appreciate their help. Thank you for the excellent service.

I had a very pleasant and trouble-free experience during the settlement of my claims after a mishap and narrow escape. The surveyor and office executives played a crucial role in making the process smooth, and I highly appreciate their help. Thank you for the excellent service.

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I want to express my gratitude for the swift action taken on my car claim. You inspected the vehicle on the very same day I made the request and provided prompt confirmation and assurance for the claim approval. I am delighted to be associated with Royal Sundaram for their spontaneous help, which has strengthened my trust in being a loyal customer for future insurance needs as well. Thank you for your excellent service!

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I am thankful for Mr. Tushar Mishra's outstanding service in helping me successfully get a cashless claim for my Hyundai Grandi10. His efficiency, gracious customer service, and quick resolution are truly appreciated. Thank you for the excellent service!

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Dr Chacko Kalliath

I'm delighted with the service from Royal Sundaram. The experience was friendly, hassle-free, and Mr. Mohankumar was incredibly helpful. I'm glad the claims process was fast and stress-free. Thank you so much! Wishing you a happy and prosperous New Year.

I'm delighted with the service from Royal Sundaram. The experience was friendly, hassle-free, and Mr. Mohankumar was incredibly helpful. I'm glad the claims process was fast and stress-free. Thank you so much! Wishing you a happy and prosperous New Year.

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Anuradha Ananth

I appreciate Mr. Anand's quick response and kind assistance in reviving the policy. Thanks to Mr. Anand and the team.

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Mr. Dinesh has been very sincere and supportive throughout our interaction these 4 days. Amazing support from Royal Sundaram.

Mr. Dinesh has been very sincere and supportive throughout our interaction these 4 days. Amazing support from Royal Sundaram.

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Thank you, for sending me the amended Policy with the change in the salutation. I appreciate your speedy and professional support and the way you kept me informed at each stage of the progress. Keep up the good work.

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I appreciate your concern and care towards helping me. Based on this positive support, I have renewed my Policy without considering any other brand. Thank you again for your support.

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Rajesh V

Keshav, please accept my appreciation for the excellent job in renewing my policy.

Keshav, please accept my appreciation for the excellent job in renewing my policy.

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The complete renewal process was quite smooth compared to previous years. I appreciate all the follow-ups done by you and the complete health retention team. I'll give 5 stars for your service and follow-ups. I hope this will remain the same going forward.

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Happy customer with family health cover. Queries resolved immediately by customer support team, especially Rajesh, trained well by Mr. Sanjeevi.

Happy customer with family health cover. Queries resolved immediately by customer support team, especially Rajesh, trained well by Mr. Sanjeevi.

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Thanks to Rajesh and team for the smooth policy endorsement with correct vehicle details. Timely response and excellent help. Keep up the good work.

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Thank you, Mary, for your support throughout the process. You went above and beyond to help me.

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Thank you for the information and excellent service. My father's cataract problem was resolved. Thanks again.

Thank you for the information and excellent service. My father's cataract problem was resolved. Thanks again.

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Surya Pratap Singh Rathore

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Thank you for the amazing customer service. You were polite and confident. Great experience.

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Jayesh C Patel

Thank you, Mr. Dinesh Kumar, for sorting out my policy renewal issue and providing solutions promptly.

Thank you, Mr. Dinesh Kumar, for sorting out my policy renewal issue and providing solutions promptly.

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Thank you, Ms. Shembau, for your quick and customer service-oriented approach in renewing my policy.

Thank you, Ms. Shembau, for your quick and customer service-oriented approach in renewing my policy.

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Thank you for the caring words and regular updates. Royal Sundaram's experience has been terrific.

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Step 1

Intimate Claim

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Step 2

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Step 3

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Why digital? The advantages of renewing your car insurance policy online

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So, there you have it - a quirky and friendly guide to renewing your car insurance policy hassle-free! Remember, keeping your ride protected is like having a trusty sidekick on all your journeys. Stay insured, stay safe, and enjoy the open road with confidence!

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Terms and Conditions

1. Declaration of Accuracy and Liability:

I/We, the proposer(s) or policyholder(s), hereby declare that the statements and particulars given in this Proposal form are complete, true, and accurate. I/We agree that Royal Sundaram Insurance Company will not be liable under the insurance contract if it is found that any of my/our statements or particulars or declarations in this proposal form or other documents are incorrect, misleading, or fraudulent in any respect, on any matter related to the grant of a cover or submission of a claim in the future.

2. Premium Payment:

I declare that the premium paid under this transaction to Royal Sundaram Insurance Company Limited is being paid by me as the proposer/policyholder through a bank account or a Credit/Debit Card or a Prepaid Payment Instrument or a UPI wallet (Wallet), held by me in my name as a primary holder (referred to as “source account”). I confirm that it is not a third-party payment made by any other person on my behalf. I understand that in the event of policy cancellation, the refund of premium as per policy terms and conditions may be credited back to such source account, and such electronic transfer will constitute full and final discharge of the Company’s obligation.

3. No Claims Bonus (NCB) Declaration:

I/We declare that the rate of NCB claimed by me/us is correct and that no claim has arisen in the expiring policy period (copy of the policy enclosed). I/We further undertake that if this declaration is found incorrect, all benefits under the policy in respect of Section I of the Policy will stand forfeited.

4. Pollution Under Control (PUC) Certificate:

I hereby affirmatively warrant that the Assured named herein/owner of the vehicle insured holds a valid Pollution Under Control (PUC) Certificate on the date of commencement of the Policy, and the same has been shown to the agent/authorized person of the intermediary. I further undertake to renew and maintain a valid and effective PUC Certificate during the duration of the Policy period. If the PUC certificate is not found valid on the date of loss, I understand that the Company reserves the right to cancel the policy.

5. Break in Insurance and Vehicle Inspection:

I/We agree that in case of a Break in Insurance, the policy would be issued subject to acceptance of risk after evaluation of the Vehicle Inspection report. Own Damage cover (Section – I) would not commence unless the satisfactory Vehicle Inspection report has been received by us. If the Company does not receive the Vehicle Inspection report or the report is adverse, the Company, at its discretion, will cancel the Policy as per the Motor Tariff.

6. Notification of Changes:

I/We further declare that I/we will notify in writing any change in the details so furnished hereinabove occurring after the proposal has been submitted but before communication of the risk acceptance by the Company. This includes changes in occupation or general health of the insured individuals.

7. Authorization and Sharing of Information:

I/We authorize the Company to share information pertaining to my proposal, including medical records, for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.

8. Consent for Communication:

By submitting my contact number and email ID, I authorize Royal Sundaram Insurance Company Limited to call, send SMS, messages over internet-based messaging applications like WhatsApp, and email to offer me information and services for the product(s) I have opted for as well as other products/services offered by Royal Sundaram Insurance Company Limited. Please note that such authorization will be over and above any registration of the contact number on TRAI’s NDNC registry.

9. Income Declaration:

This policy has been issued based on my declaration of Gross Annual Income, and the Base Sum Insured chosen is not more than 10 times of such Gross Annual Income. In the event the declaration is found to be incorrect/wrong and/or non-submission of income proof to justify this declaration, it may result in the inadmissibility of a claim and/or cancellation of the policy. I confirm that the Gross Annual Income of the family in this proposal is true and correct and undertake to submit relevant income proof(s) in the event of a claim in this regard.

10. Occupational Exclusions:

I confirm that the insured member(s) under this Policy do not work in Nuclear power plants, underground mines, explosives, hazardous material (e.g., fertilizers, asbestos fiber, toxic gases, toxic chemicals, pesticides, etc.). Furthermore, the insured member(s) do not work in underground mines, explosive magazines, or electrical installations with high tension supply, or are jockeys, circus personnel, engaged in racing on wheels or horseback, big game hunting, mountaineering, winter sports, skiing, ice hockey, river rafting, polo, or similar activities or occupations.

11. Declaration as Authorized Proposer:

I declare that all the information I have provided is true and accurate to the best of my knowledge, and I am authorized to propose on behalf of my family.

12. Underwriting Policy and Premium Payment:

I declare that the premium paid under this transaction to Royal Sundaram Insurance Company Limited is being paid by me as the proposer/policyholder through a bank account or a Credit/Debit Card or a Prepaid Payment Instrument or a UPI wallet (Wallet), held by me in my name as a primary holder (referred to as “source account”). I confirm that it is not a third-party payment made by any other person on my behalf. I understand that in the event of policy cancellation, the refund of premium as per policy terms and conditions may be credited back to such source account, and such electronic transfer will constitute full and final discharge of the Company’s obligation.

13. Authorization for Medical Information:

I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured/proposer or from any past or present employer concerning anything that affects the physical or mental health of the person to be insured/proposer. I also authorize the company to seek information from any insurer to whom an application for insurance on the person to be insured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.

14. Information Sharing:

I hereby permit/authorize Royal Sundaram Insurance Company Limited to collect, store, communicate, and process information relating to the policy(ies) and all transactions related therewith, including the sharing and disclosing the public authorities of any confidential information as required by law. I also authorize Royal Sundaram Insurance Company Limited to send me information in relation to the Policy and Royal Sundaram Insurance products & services, irrespective of whether I am registered with the National Customer Preference Register (NCPR) (formerly the National Do Not Call Registry) or not.

15. Consent for Electronic Communication:

To protect the environment and save paper, I consent to Royal Sundaram contacting me by email or phone instead of in physical form and to share all documents, updates, and alerts electronically.

16. Liability Commencement:

The Company's liability does not begin until the full premium has been collected by the Company, and the acceptance of the proposal has been formally intimated to the insured.

17. General Exclusions:

The Company shall not be liable under this Policy in respect of any accidental loss or damage and/or liability caused, sustained, or incurred outside the geographical area; any claim arising out of any contractual liability; any accidental loss, damage, and/or liability caused, sustained, or incurred whilst the vehicle insured herein is being used otherwise than in accordance with the Limitations as to Use or being driven by or is for the purpose of being driven by him/her in the charge of any person other than a Driver as stated in the Driver’s Clause; any accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising therefrom or any consequential loss; any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purposes of this exception, combustion shall include any self-sustaining process of nuclear fission; any accidental loss damage or liability directly or indirectly caused by or contributed to by or arising from nuclear weapons material; any accidental loss or damage and/or liability directly or indirectly or proximately or remotely occasioned by or contributed to by or traceable to or arising out of or in connection with war, invasion, the act of foreign enemies, hostilities or warlike operations (whether before or after the declaration of war), civil war, mutiny rebellion, military or usurped power, or by any direct or indirect consequences of any of the said occurrences, and in the event of any claim hereunder, the Insured shall prove that the accidental loss, damage, and/or liability arose independently of and was in no way connected with or occasioned by or contributed to by or traceable to any of the said occurrences or any consequences thereof, and in default of such proof, the Company shall not be liable to make any payment in respect of such a claim.

18. Authorization as Proposer and Information Accuracy:

I/We hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers, and/or particulars given by me are true, complete, and accurate to the best of my knowledge. I/We am/are authorized to propose on behalf of these other persons. I understand that the information provided by me will form the basis of the insurance policy and is subject to the Board-approved underwriting policy of the insurance company. The policy will come into force only after full receipt of the premium chargeable.

I/We undertake that the applicable loadings have been informed and understood by me. I further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance by the company.

I/We declare and consent to the company seeking medical information from any doctor or hospital who at any time has attended on the life to be insured/proposer or from any past or present employer concerning anything that affects the physical or mental health of the life to be assured/proposer. I also authorize the company to seek information from any insurance company to which an application for insurance on the life to be assured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.

Additionally, I/We authorize the company to share information pertaining to my proposal, including medical records, for the sole purpose of proposal underwriting and/or claims settlement, with any Governmental and/or Regulatory authority.

Please refer to the policy documents for complete details of exclusions, inclusions, and terms and conditions.

For any further information or clarification, please feel free to contact Royal Sundaram Insurance at the following contact details:

Royal Sundaram General Insurance Co. Limited

Corporate Office Address :

Vishranthi Melaram Towers, No.2/319 , Rajiv Gandhi Salai (OMR), Karapakkam , Chennai - 600097.

Telephone : 91-44-7117 7117

Fax : 044 – 7117 7140