Page 55 - Insurance Times February 2021

LEGAL

Vehicle Insurance

Ombudsman asks Bajaj Allianz to pay written to the Reserve Bank of India (RBI) and the insurance

medical bill of Covid patient regulator, IRDA to look into complaints of failed
transactions but money not reversed, delay in crediting the
Milind Kharat, Insurance Ombudsman, Mumbai & Goa, has amount and inordinate time taken in processing of
directed Bajaj Allianz General Insurance, to pay one of its insurance claims.
customers the entire hospitalization expenses, barring non-
medical items, incurred for Covid-19 treatment. It has urged the IRDA to take up the issue of addressing
consumer grievances with the insurance companies and
Abhay Chhapia, who had bought a health insurance policy direct them to adhere to the timelines stipulated in the
from Bajaj Allianz General Insurance, with a sum assured IRDAI Protection of Policyholders' Interest Regulations,
of Rs 30 lakh, had availed of medical treatment in Mumbai
based Wockhardt Hospital for Covid-19. 2017.
The CCPA wrote to the IRDA and RBI recently after
However, Chhapia had filed a complaint with the
Ombudsman against short-settlement of a claim lodged analysing consumer grievances received in the National
under the policy by Bajaj Allianz General Insurance. He Consumer Helpline (NCH), which is being run by the
complained that a claim lodged for Rs 3.1 lakh for the consumer affairs department. The CCPA analysed
treatment of Covid-19 (positive) undergone by him at complaints lodged between April and December 20.
Wockhardt Hospital was settled by Bajaj Allianz General The NCH data show that out of 6,018 grievances registered
Insurance on cashless basis with a deduction of Rs.1.3 lakh relating to the insurance sector, nearly 1,200 pertained to
almost half the amount of claim. delay in getting the claim amount. "You may agree that
He stated that he has been associated with the company the two most important factors that influence consumer
for many years and further argued that he, as an individual, satisfaction in the insurance sector - aside from the
has no say or bargaining power in front of the hospital and perceived fairness of the settlement itself - are the speed
had to pay whatever amount was charged to him. and transparency of the claims process," CCPA chief
After scrutinising the documents produced on record commissioner, Nidhi Khare wrote to IRDA chairman, S C
coupled with the depositions of both the parties, Kharat Khuntia.
observed that the hospital has not adhered to Preferred
Provider Network (PPN) rates and has overcharged the Govt mulls online filing of complaints
patient in violation of their agreement with the Bajaj Allianz with insurance ombudsman
General Insurance.
The finance ministry recently issued a draft Insurance

CCPA instructs RBI and IRDAI to check Ombudsman (Amendment) Rules, 2020, to amend the 2017
Insurance Ombudsman Rules. Under the new rules, the
cases of Failed transactions Council for Insurance Ombudsmen will take over the duties
The Central Consumer Protection Authority (CCPA) has of the Executive Council of Insurers.

The Insurance Times, February 2021