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Oriental Insurance Scraps Covers For 3 Tainted IPL Players

IPL Spot Fixing

Following the Indian Premier League franchise –Rajasthan Royals – terminating the contracts of its three players on spot fixing charges, the franchise’s official insurer Oriental Insurance too has canceled the insurance covers given to the trio.

After taking the nod from the franchise, Oriental Insurance has cancelled the policy of three players. This is because if the players are jailed or something untoward happens to them, there would be claims.

The trio was insured for a personal accident insurance policy, medical insurance policy and baggage insurance.

S Sreesanth has a personal accident cover of Rs 18 crores, a medical insurance policy of $1 million and baggage insurance of Rs 2,00,000. In case of a mishap, the medical insurance policy even allows an auctioned player to air lifted and flown to a foreign country for medical treatment.

The other two players – Ajit Chandila and Ankeet Chavan has a personal accident insurance of one crores, medical insurance of Rs 5 lakh and baggage insurance of Rs 2, 00,000.

The insurance covers had commenced from March 25 and would end on May 31, after the finals.

The three players were arrested last week on charges of spot-fixing in the ongoing IPL matches.

PSU General Insurer’s Net Profit Up In FY’13

PSU General Insurer

On the back of growth in premium collection and reduction in losses, public sector general insurers have reported a rise in their net profits for the financial year 2012-13.

Insurers, including the New India Assurance, United India Insurance and Oriental Insurance, have seen an increase in Profit After Tax (PAT) for FY’13.

New India Assurance has posted a PAT of Rs 843.6 crores for FY’13 as against Rs 179.3 crores in FY’12. The company’s total premium collection stood at Rs 10,038 crores in India in FY’13, a growth of 18% over the last financial year. The company’s foreign operations, spread over 22 countries, generated a premium of 2,467 crores, up 17.6% over the previous financial year.

United India Insurance has posted a growth of 36% in PAT at Rs 527 crores for FY’13 as against Rs 387 crores in FY’12. Company’s premium collection stood at Rs 9,266 crores in FY’13, up 13% over the last fiscal.

Similarly, Oriental Insurance almost doubled its PAT in FY’13, at Rs 794.7 crores.

For most public sector general insurers, underwriting losses have come down significantly due to the dismantling of the third party motor pool for commercial vehicles. This was replaced by the declined risk pool from first April 2012.

PSU General Insurers Latch on to Investment Income

PSU General Insurer

Coming day’s looks promising for the general insurance industry, as on the one hand with rising stock markets there equity investments are soaring, and on the other hand they are reducing discounts on premiums and offloading high risk portfolios. This scenario looks to be a best possible bet for them to make up for their underwriting losses.

All four PSU general insurers – New India Assurance, National Insurance, Oriental Insurance and United India Insurance are optimistic about a better equity investment this fiscal.

The investment income of New India Assurance grew over Rs 300 crores in April-December 2012 to Rs 2,055 crores from Rs 1,709.14 crores in the previous fiscal. More than half of this investment return has come from its equity portfolio. The company say that since it is an active participant in the capital market, it analyse the stock movement well and get invested in it.

Oriental insurance also registered a profit of around Rs 450 crores for the quarter ended December 2012. The total investment income of Oriental insurance and book value stands now at over Rs 1,700 crores and Rs 1,100 crores, respectively.

The case is no different at United India insurance, where the total investment income came in close to Rs 1,500 crores in April-December.

As of 5 February 2013, the stake value of National insurance and Oriental insurance stood at Rs 4,298 crores and Rs 4,429 crores, respectively.

Investment portfolios can sometimes yield returns that can cushion the impact of a poor underwriting performance. An underwriting performance refers to profits after claims payment and expenses. Of late, PSU general insurers have been under strain on this front, faced with bleeding portfolios on third party policies, group health and fire.

In a bid to curtail losses from group health insurance portfolio, the finance ministry last year had suggested that insurers should do away with loss-making businesses, cut down on discounts and take steps to make it a less competitive scenario for themselves. These steps has lead to a overall drop of around 4-5% in combined loss ratio (losses incurred plus adjusted expenses) for all the four PSU general insurance companies.

Underwriting loss of PSU general insurers declined by 22.94% to Rs 5,817 crores in FY’12 from Rs 7,549 crores in FY’11.

PSU General Insurers Planning to Expand Abroad

PSU General Insurer

To tap the Indian Diaspora, four public sector general insurers –New India Assurance, Oriental Insurance, National insurance and United India Insurance – are considering to expand their operations to other countries in the next financial year.

Given the large number of Indians and Indian businesses in South-east Asia, West Asia and Africa, these regions are emerging as preferred destinations.

Oriental Insurance: It is currently present in Dubai, Kuwait and Nepal. It is the only Indian company to have operations in Qatar. It is also planning to partner a reinsurance company in Nepal, subject to government and Insurance Regulatory and Development Authority’s (IRDA) approvals. The company’s current equity in the insurance pool in Nepal would be transferred to the new Insurance Company. The insurance pool in Nepal was created to provide reinsurance cover against damages resulted from terror activities.

New India Assurance: It is keen to extend operations to Canada, Qatar and Myanmar. At present, company has 27 offices across the globe. Company is also exploring opportunities across Africa. Company also has presence in Nigeria.

United India Insurance: It would seek to expand in South-east Asia and West Asia in next financial year. Company is seeing opportunity in Sri Lanka because several Indian businesses are based there.

National Insurance: At present it has one international office and it is planning to expand to other areas.

Four PSU General Insurers, Life Insurance Corporation of India (LIC) and General Insurance Corporation of India (GIC) have a joint venture called ‘KenIndia’ in Kenya that offers life, non-life and health insurance products.

Four PSU General Insurance companies are also considering forming a joint venture to expand in Africa.

More Offshore Drilling Opens Up Market for Insurers

ongcWith Indian oil and gas exploration companies such as Reliance Industries and Oil & Natural Gas Corporation (ONGC) getting into more offshore drilling, new opportunities have opened up for insurers.

The insurance companies are seeing increase in loss limits (higher compensation in case of any mishap) in the deals.

New trends such as protection against seepage and pollution damages and governance risks are also picking up.

Some of the domestic general insurance companies such as ICICI Lombard General Insurance and Oriental Insurance are coming up with very specific insurance products.

Globally, an oil exploration company has an average loss limit of around $4 billion for offshore operations. However, in India, the limit is in the range of $0.5-1.5 billion.

When the loss limit crosses $1 billion, it needs to be handled carefully. However, insurers are not getting into reserve insurance. Generally insurance companies do not prefer insuring reserves because they do not have the expertise to re-affirm reserves estimates provided by an explorer. At the same time, upstream sectors also do not see many ‘loss of productivity income policy’.

Loss of productivity means hydrocarbon output is below estimates leading to loss of revenue.

But downstream companies such as refiners and petrochemical companies opt for loss of productivity income policy.

Insurers Became More Efficient in Settling Travel Claims

travel claimNon-Life Insurance Companies have become more efficient in settling travel claims, this becomes evident as they are seeing rise in claim settlement within one month of claim registration for overseas travel insurance policies.

Out of the total 4,602 claims settled by seven non-life insurers in the April-June quarter of financial year 2012-13 (Q1FY13), 47.9% or 2,205 claims were settled within one month. In the same period last year, these insurers settled 5,796 claims out of which 43.7% or 2,535 claims were settled within one month.

The seven non-life insurers which were considered for this analysis are TATA AIG General Insurance, Oriental Insurance, ICICI Lombard General Insurance , Bajaj Allianz General Insurance, HDFC Ergo General Insurance, Reliance General Insurance and Cholamandalam MS General Insurance.

These insurers settled 48.5% or 2,768 claims out of the total 5,703 claims within one month in January-March quarter of FY’12.

These insurers settled 32% or 1,466 claims out of their total claims beyond one month but within three months of claim registration in April-June 2012 period. In the same period last year, these insurers settled 33.5% or 1,939 claims beyond one month but within three months of claim registration. In Q4FY12, out of total claims settled, 20.7% or 1,182 claims were settled beyond one month but within three months of claim registration.

Similarly, 20.2% or 931 claim settlements took more than three month but less than one year in Q1FY13 compared with 22.8% or 1,322 claim settlements in same period last year. However, insurers took more than three months but less than one year to settle 30.7% or 1,753 claims out of the total settled claims in Q4FY12.

Travel insurance policies generally cover policyholders against any medical emergency, accidents, loss of baggage, loss of travel documents including passport and accidental loss to any third party.

For medical and accidental emergencies, insurers require hospitalization documents and bills, for any other type of loss, they ask for police report.

As per insurers, if a policyholder is traveling for a long duration than document completion is delayed till he returns to the country, which delays the claim settlement process.  However, in case of hospitalization, claims are settled on cashless basis in co-ordination with Third Party Administrators (TPAs).

HDFC Ergo settled highest number of claims within one month as a proportion of the total claims settled in Q1FY13. Out of total 1,727 settled claims, 68% or 1,176 claims were settled within one month.

TATA AIG General settled 44.2% or 508 claims out of the total 1,150 claims within one month.

Bajaj Allianz General settled 42.7% or 406 claims out of the total 950 claims within one month.

Reliance General took more than three months but less than one year in settling 52.5% or 31 claims out of the total 59 settled claims in Q1FY13.

ICICI Lombard General took more than three months but less than one year in settling 45.8% or 313 claims out of the total 683 claims.

Limited Cover for Alternative Treatments

limited coverDraft norms on health insurance announced earlier this year, allowed insurers to cover non-allopathic treatments done in government hospitals and medical colleges. But general insurance companies have started working on products covering alternative medical treatments such as ayurveda, homoeopathy, unani, sidha and naturopathy long before that.

But experts have not seen much attraction for products extending this benefit. Take for instance, although Cholamandalam MS General Insurance launched Chola Individual Healthline insurance policy last year, but it has not seen much attraction for this product as it had expected.

It is perceived that people flock to non-allopathic treatments. But it is not true, as up to 90% people believe in allopathy in case of major illnesses for instant relief. Non-allopathic treatments are opted for only in case of non-fatal illness.

While, Chola Individual Healthline insurance policy is a stand alone cover, some insurers offer coverage for alternative treatments only under their group health insurance policies like Bajaj Allianz General Insurance.

Insurers like Oriental Insurance, New India Assurance, TATA AIG General Insurance, HDFC Ergo and Star Health and Allied Insurance cover alternative medical treatments under standalone or individual health insurance policies.

No standalone health cover for alternative treatments is available; you have to buy a standard health insurance cover from one of these insurers, which will also cover non-allopathic treatments.

Though many policies offer this benefit, there are curves on the amount and situations under which you can make a claim. For example, treatment under naturopathy is excluded from most of these policies. Experts say that there is no standard protocol in case of alternative treatments. Add to that, costs of each of this medication system vary. This makes computation of cover difficult for insurers. Even under ayurveda, some policies cover select procedures only.

Cholamandalam MS General Insurance’s product covers only ayurvedic treatments, which can be claimed if you are hospitalized for more than 24 hours. On the other hand though New India Assurance covers individuals getting treated with the help of ayurveda, homoeopathy and unani medicines, a claim can be made only to the extent of 25% of the sum insured. More over, treatment should be availed at a government hospital.

Similarly, Star Health and Allied Insurance’s product does not cover naturopathy, and for ayurvedic, homoeopathy, sidha and unani medicines, you can claim up to 25% of the sum insured or a maximum of Rs 25,000 per occurrence, per policy year.

Though the benefits are capped, you will be required to pay for the entire policy. For instance, a 35 years old will need to pay a annual premium of Rs 11,322 for Cholamandalam MS General’s product, for a sum assured of Rs 4.50 lakh. For non-allopathic cover it will be 33,750.

Similarly, for TATA AIG General’s product, a 35 year old will need to pay an annual premium of Rs 5,000 for a sum assured of Rs 5 lakh. And for non-allopathic cover he will need to pay an annual premium of Rs 25,000.

If your claim for alternative medication is accepted, insurers like HDFC Ergo do not accept another claim for allopathic treatment for the same disease.

Hence, cover for non-allopathic treatment can also be looked at the time of buying a health insurance policy but it can’t be one of the main criteria for buying a health insurance policy.

Looking at the cover to premium ratios, you could also do without this benefit because in most cases no hospitalization is required for ayurvedic and homoeopathic treatments. Also most of the people turn to alternative medication, when allopathy gives up the case and then there is hardly anything one can do.

Hence, it is advisable to have a comprehensive health plan, which covers hospitalization in serious or emergency situations. And for additional treatments you could have a small kitty in place.

IRDA Working On Centralized Mechanism to Improve Health Insurance Service

IRDA-PersistencyIn a bid to improve servicing and prevent misuse of mediclaim benefits by hospitals, Insurance Regulatory and Development Authority (IRDA) is working on a centralized mechanism to capture health insurance data.

With this system, IRDA will capture data pertaining to health insurance systems and entire medical process and billing claims. This system will not only improve health insurance servicing but also prevent over-billing by hospitals.

In the long run, it will also be useful in developing a code in line with the global practice, besides reducing the cost of health insurance and increasing its reach.

The health insurance sector is facing problems because of high cost to claim ratio. As of June 2012, the cost ratio for the public sector companies was 140% of the premium received under the health portfolio.

Insurance companies have a network of hospitals, known as PPN, which offers health insurance services under cashless facility. The network hospitals are decided through an agreement between Third Party Administrators (TPAs) and hospitals. The list of network hospitals is amended from time to time.

Four PSU general insurers –New India Assurance, Oriental Insurance, National Insurance and United India Insurance- had in July last year stopped the cashless facility in select private hospitals, alleging over-billing.

The companies had alleged that some of the hospitals were charging the patients having health insurance policies at rates which were quite higher than the reasonable cost of treatment.

After this, IRDA in august came out with a circular stating that the policyholders undergoing treatment will continue to get cashless benefit even if the hospital where they are admitted is delisted by the insurers from cashless cover. IRDA has also asked companies to regularly update policyholders on any change in the list of hospitals offering cashless cover.

CRPF Employee Awarded Rs 6.11 Lakh as Compensation

Motor Accidents Claims Tribunal (MACT) has directed Oriental Insurance to pay Rs 6.11 lakh compensation to Dalbir Singh, a CRPF employee who suffered 54% permanent disability in a road mishap. However, MACT deducted 25% of total damage by saying that victim was driving his bike in drunken state.

The MACT presiding officer, Arun Bhardwaj, had initially awarded a compensation of Rs 8.15 lakh to 39 years old Dalbir Singh but later on reduced it to Rs 6.11 lakh, observing that he was also responsible for contributory negligence as he was driving his bike under the influence of liquor.

MACT held that petitioner was responsible to an extent of 25% for contributing to the accident as he was driving the bike in drunken condition. Hence, the total compensation payable to the petitioner was Rs 8.15 lakh but as the petitioner was 25% responsible for contributory negligence, the total compensation payable to the petitioner is Rs 6.11 lakh.

On 26 October 2008, night Dalbir Singh was hit by a rashly-driven tempo at high speed near St. Mary’s School, Dwarka, New Delhi. Then he was rushed to the Deen Dayal Upadhyay Hospital. And hospital in its report said that Dalbir Singh had suffered 54% permanent disability in the right side of his body.

Ramesh Kumar and Ram Kishan, the driver and owner of the tempo respectively, in their statements said that incidence did not take place due to negligence of the driver and their tempo was not the offending vehicle.

On the other hand, the insurance company had argued that even if it was proved that the offending vehicle was being driven by the driver, but victim was responsible for the accident as he was driving under the influence of alcohol and hence, he is not entitled to any compensation from the driver.

However, MACT rejected the argument of the insurance company citing that insurance company has not proved any defense and it has not brought any evidence on record to show that the insured vehicle was not involved in the accident. Therefore, compensation is payable by the insurance company.

PSU Insurers to Set Up Common TPA within Six Months

PSU General InsurerWithin the next six months, government-owned insurance companies will have an in-house Third Party Administrator (TPA) system.

In the common TPA, four general insurers -New India Assurance, United India Insurance, National Insurance and Oriental Insurance will have equal stake, while Life Insurance Corporation of India (LIC) and General Insurance Corporation of India (GIC) might have lesser stake. This is because common TPA has been designed to meet the needs of the PSU General Insurers.

The common TPA has been proposed to minimize fraud claims in the health insurance segment. It is also expected that common TPA will help to speed up the claim settlement process and reduce the claim’s ratio of insurance companies. At present, insurance companies pay a commission of 6% of premiums to TPAs to settle claims.