The Hindu Business Line : Consumers may get a say in mediclaim settlements

Kolkata, June 30 Consumer representatives may get a say in claims settlement for mediclaim policies if the recommendations of the Third Party Administrator Committee are accepted by the insurance regulator.

The committee headed by Mr S. B. Mathur, Secretary-General of the Life Insurance Council, has recommended the formation of a common body comprising members from the TPAs, life and non-life insurance companies and hospitals and representatives from consumer groups.

Cashless claims

The proposed body is expected to simplify and speed up cashless claims settlement of insurance policies. The body, it is proposed, would address claims-related complaints by hospitals and take the views of the nominated consumer representatives and other stakeholders in settling disputes. Its operation is expected to be independent of the insurance ombudsmen services. The Ministry of Health, through its Directorate-General, might also facilitate in the functioning of the new body, Mr Mathur said. “We have suggested to the Insurance Regulatory and Development Authority to nominate one or two representatives to look after customer interest,” he said.

The nominees, he pointed out, would not necessarily have to be members of consumer associations. Currently, the policyholders have to rely solely on the TPAs which are intermediaries between insurance companies and hospitals for settlements of claims. There are 27 IRDA-approved TPAs across the country.

“The lack of coordination and the consequent blame game among the different stakeholders had thrown up a lot of problems,” Mr Mathur said, adding that the objective of the proposed body would be to help standardise the settlement procedures and bring transparency to the system. Hospitals now are not under the IRDA and their representation in the proposed body therefore could at least make them more accountable, he added.

Doubling of capital

The panel has also recommended doubling the minimum capital requirement for TPAs to Rs 2 crore. It has proposed extending licence to a TPA only if it is present in at least six locations. These regulations, however, are not particularly aimed at ranking of TPAs, he added.