CHENNAI: Chennai sees more people fighting with insurance companies over settling their health insurance claims, said B N Mishra, current ombudsman of Chennai.
Mishra, who is the insurance ombudsman of Orissa, has been given additional charge of Chennai. "While Bhubaneswar sees a lot of disputes over death claims, in Chennai predominantly problems arise over not disclosing pre-existing medical conditions and other medical disputes," said Mishra on Bima Lokpal Day observed on Thursday.
The Chennai Ombudsman office has zero cases pending at the end of the year, second time in a row. During the year 2015-16, Chennai centre received in all 1,170 complaints. Of this 303 cases were given awards amounting to Rs188.25 lakh. More than 67% of awards were skewed in favour of policyholders.
The number of complaints received, declined 23% year-over-year in FY16 compared to 1,527 in FY15. This compares to 1,952 complaints received the previous year.
The Ombudsman received more complaints from private insurers than the public-sector insurance companies. In life, LIC saw 272 complaints compared to 384 complaints against private life insurers. LIC has more than 70% of the life insurancemarket. In general insurance also, the four PSUs saw 239 complaints versus 275 complaints registered against private general insurers.
Among private life insurers, HDFC Standard Life Insurance saw the most number of complaints at 77. In general insurance, Star Health and Allied Insurance saw as many as 97 complaints registered.
When it came to policy-type, life insurance industry saw more than 86% claims from traditional policies and 4% from ULIPs, 7% from pension plans and 2% from health products. Since July 2016, life insurers have been prohibited from selling health products.
In the general insurance industry, more than 53% disputes arose from non-settlement of individual mediclaim policies. Followed by motor at 21%, group-mediclaims at 12%.
"With the Chennai floods, we also saw an increase in the number of disputes over settlement of home insurance claims," said Mishra. In one instance that the ombudsman settled K Ramachandran was denied repayment for his flood-damaged house by Royal Sundaram General Insurance, which claimed that the policy did not cover damage by rain water.
The Ombudsman awarded the dispute in favour of Ramachandran, stating that the insurer must take into account the incessant, heavy rain that battered Chennai from December 1-3. With more than 49 cm of rain reported in the city, the insurer's surveyor failed to observe the level and duration of water logging. "Damage suffered by other buildings in the vicinity, exact cause of damage and age of the building was not assessed," observed the ombudsman.
Since the insured's location was one of the worst-affected areas in the Chennai floods, the insurer cannot ignore the claim, said the Ombudsman.
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