Shri C.S. Murthy, Saidabad, Hyderabad has addressed a letter
to the Chairman, LIC of India, Mumbai on renewal of Group Medi-claim Policy for
the financial year 2013-14. He says that
irreparable financial loss/damage is inflicted on beneficiaries by New India
Assurance Co. Ltd. with inflated claim figures.
And as such, he demands that RENEWAL MUST NOT BE ALLOWED. He has advanced his arguments to press his
demand.
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Shri Murthy writes that
his “experience proved that the Regional Offices of New India Assurance Co. Ltd.
were found to be more reliable and dependable. The data from Regional Offices of NIA usually
disputed the claim figures projected by NIA Divisional Office, Mumbai which
issued the policy.”
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He has noted the
following points in defence of his arguments that the whole scheme is not
properly managed :- Click 'Read more' below.
(a) Counter check by Central
Office, LIC with the claims settled data from LIC DOs is given a go bye.
(b) New India walked
away with at least 50 crores profit in just 2 fyrs in the guise of being lowest
tenderer. Last minute high drama is being played by New India to retain
business with them. It is allowed by Central
Office.
(c) Administer medi-claim
policy by LIC itself as 'term insurance' element is absent. What is being
offered is just reimbursement of medical expenses claimed on hospitalization.
It is only a scheme and not insurance.
(d) 90% of beneficiaries
(out of 4, 44,000) do not prefer any claim. Hence scheme is generating surplus.
If the scheme is implemented and
administered by LIC, many more additional advantages/coverages without
hospitalization could be granted and at the same time generate huge amounts as
surplus.
(e) Without at least 40% Group Discount, to
call the policy as Group Policy is a misnomer.
(f) When policy was
running under low claim ratio, why claim for refund of excess premium is not
preferred against New India? Why LIC is reluctant
to invoke relevant clause, to obviate the present situation where the beneficiaries are losers.
(g) Due to reluctance to
examine and analyze claims settled, excess premium is being collected from
employees and pensioners and the same is simply passed on to New India under
tender system. NIA is confident that LIC
will never confront them because LIC does not possess any data on claims settled
by insurer. Our practice of simply relying
on data from NIA is responsible for the financial loss inflicted on the
beneficiaries. This is the crux of the problem. Instead of tender system, why basic tariff
premium is not ascertained from the public sector general insurance companies and
then work out liability by allowing all permissible discounts.
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Raising the above
arguments, Shri Murthy has sent to LIC comparative data on claims paid for full
5 years from 2006 to 11 and requested to give a fair trial to administer the
scheme at least for one fyr 2013-14 and feel the difference.
(a) The change over to
administer the scheme by LIC’s own offices is very simple and it does not
require any super or specialized intelligence.
Except underwriting, the
entire process of reimbursement is being done by LIC offices - OS Dept (premium is collected, reimbursement form is provided, claim for reimbursement
forwarded to insurer, LIC issues Cheques for the amount approved by insurer.) Then why depend on outside insurer. Is
it for only underwriting? Doesn’t LIC
Possess the expertise? Are we lacking
experience in underwriting?
(b) From all angles the
scheme paid rich dividends to NIA and NIA minted and reaped super profits which
could have and should have been retained with us by administering the policy by
LIC itself through LIC Divisional Offices without incurring additional
expenditure.
(c) Honeymoon with
outside agency is enough and enough. Better it is delinked.
(d) The initiative is
still in your hands and this is the proper time to act.
Also please stop the future loss by
administering the scheme for ourselves from FYR
2013-14.