Public sector non-life insurers have better claim settlement in health insurance segment over the last quarter of FY’12 (January-March 2012) compared to other players in the industry. These are the findings of an analysis, which covered eight non-life insurance companies which included two public sector insurers, five private sector insurers and one stand-alone health insurer.
Total number of claims handled by these eight insurers was 36, 48,054. Out of these claims, 50% claims were settled while 1.4% claims were repudiated, and 47.94% claims were outstanding.
Oriental Insurance settled around 92.1% of their total claims of 1,06,771, in the March quarter, while United India Insurance settled 88.6% of 4,43,624 claims during the same period.
These total claims comprise the new claims filed by the policyholders in the March quarter as well as claims that have been pending with insurers as of the end of December 2011.
In private insurers, Bajaj Allianz General Insurance settled 85.1% claims out of 27,086 claims. HDFC Ergo settled 68.2% of their total claims of 18,528.
Analysis also revealed that HDFC Ergo repudiated 15.53% of its total claims and Bajaj Allianz General repudiated 7.44% claims.
Oriental insurance repudiated 0.28% of their total claims. And Reliance General Insurance repudiated 0.53% of their total claims.
As per insurers claims are repudiated if their underwriting team finds that claim is due to some pre-existing disease or hospitalization is not availed for 24 hours. Apart from these a claim is also repudiated if documents related to health claim are not submitted completely or delayed.
In order to make claim settlement a quick process, insurers are moving to in-house third-party administrator (TPA) model for retail health insurance segment.
Of eight insurers Reliance general insurance and ICICI Lombard general insurance has 65.4% and 56.6% claims pending for last quarter respectively. As per Reliance general, very large number of their claims is coming from new government outpatient scheme. In these policies, although customers have received treatment, it will continue to show under pending claims because the hospital bills are settled in bulk.
On the other hand pending claims for Bajaj Allianz General Insurance and Oriental Insurance stands at 7.5% and 7.6% respectively.