Page 24 - Life Insurance underwriting Ebook IC 22

g) Issue of policy document

2. Describe the structure of the Underwriting function.
a) Care underwriting team

Some of the main duties and responsibilities include:

 Underwriting medical and non-medical proposals in accordance with the
guideline lay down by the insurance company and the regulators.
 Devising underwriting guidelines according to legal and market conditions and
communicating changes to departments and all concerned.
 Developing and implementing policies and procedures for the underwriting
department.
 Referring and recommending proposals to the reinsurers which are beyond their
scope of authority.
 Maintaining MIS of the business received and underwritten.

b) Medical Team or TPA Team

Some of the main duties and responsibilities include:

 Proper liaising and timely payments to the TPAs for medical tests done them on
a regular basis.
 Managing and controlling of TPA and quality-control checks put in place respect
to medical reporting by carious diagnostic centers.
 Daily correspondence with TPA for medical cases.
 Maintaining daily MIS with respect to all activities of TPAs and following or each
of the activities with the concerned officers.

c) Chief Medical Officer (CMO)

Chief medical officer or medical director in an insurance company is all a doctor with
long standing experience in the field of general medicine cardiology and who brings
along a wide range of experience in practicing medicine.

 Other than opining on craniological reports. he is able to apply his current
medical knowledge to enhance the company's ability to place profitable business
by undertaking research, training and providing technical expertise in the framing
of underwriting guidelines

 An extended role for a CMO may include participation in claim adjudication.
helping in the adjudication of medico-legal cases of claims marketing actuarial
and other areas of company operations etc

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