The Hindu Business Line : Disputes over mediclaims settlement on the rise

Hyderabad, Aug. 7 Complaints pertaining to settlement of mediclaims by health insurance companies are on the rise, according to the data available with the Insurance Ombudsman.

Also complaints relating to issues such as lack of transparency in settlement of medical claims are growing of late, Mr P.A. Chowdary, Ombudsman, told Business Line.

“While most of the claims are being rejected by the insurance provider on the grounds of ‘pre-existence of disease’, there is no clarity on the upper limit of claims and diseases covered,” he said.

Settlement of overseas mediclaims was also becoming an issue with the increase in the number of people going abroad on work, he added. In both life and non-life, complaints on settlements are on the rise.

For instance, as per the data of office of the Governing Body of Insurance Council, about 7,420 complaints were made to Insurance Ombudsmen in the 12 circles in the country between April and December 2006. Kolkata has a major share with over 1,300 complaints, followed by Mumbai with 1091 , Lucknow 907, Chennai 870 and Hyderabad 947, among others.

“Generally there are more complaints (about two-thirds) from non-life pertaining to motor insurance and other related aspects. Over two thirds of the complaints settled were in the non-life sector,” Mr Chowdary said.

According to Mr Srinivas Rao, Deputy Secretary (Non-Life) office of Insurance Ombudsman here, the reason for increasing litigation in motor insurance was the non-transfer of insurance documents in the pre-owned vehicle segment.