Page 12 - Insurance Times July 2023

Moderate alcohol intake ted for his medical treatment in the
ESIC-run social security
hospital from 8.5.2018 to 14.5.2018.
can't be ground for reject-
scheme adds 1.3 million The complainant incurred Rs. 1,28,677
ing medical claim for his entire treatment. But the com-
members in March
plainant said, his claim for reimburse-
The district consumer grievances
Over 13 lakh new members joined
ment was rejected by the insurer com-
redressal forum in a recently passed
the Employees'State Insurance
pany, and he was only discharged after
order said moderate consumption of
Corporation or ESIC-run social se-
his family paid out-of-pocket. In its re-
alcohol cannot be used as grounds to
curity scheme in March 2023, ac-
reject medical insurance claims. The sponse, New India Assurance Company
cording to an official data released
said Saini had not disclosed at the time
Forum directed New India Assurance
recently.
of taking the policy that he was suffer-
Company Limited to reimburse com-
The latest data is part of a report ing from a pre-existing disease "liver
plainant Giani Ram Saini (51) Rs.
-- Payroll Reporting in India: An abscess being a chronic alcoholic".
1,28,677 which was incurred by the
Employment Perspective - March,
complainant on his medical treatment
2023 -- released by the National
along with interest at 9% per annum. Life insurer Tata AIA looks
Statistical Office (NSO).
The complainant is also entitled to at health covers
It showed that the gross new en-
compensation of Rs. 50,000 as well as Tata AIA Life Insurance is looking to
rolments with ESIC rose to 1.49
Rs. 22,000 as litigation expenses. The increase its presence in health covers.
crore in 2021-22, from 1.15 crore
rejection was on the grounds of Giani
The company aims to provide short-
in 2020-21. It was 1.51 crore in
Ram Saini had not disclosed at the time term health insurance and indemnity
2019-20 and 1.49 crore in 2018-
of taking the policy that he was suffer-
plans if regulator IRDAI's proposal to
19.
ing from a pre-existing disease "liver
allow insurers a composite licence for
The report said gross new enrol- abscess being a chronic alcoholic".
life and non-life policies becomes law.
ments with ESIC from September
Saini in his complaint said he his wife Tata AIA is currently present in long-
2017 to March 2023 were 8.6
and children had held the health insur- term health covers with fixed benefits.
crore.
ance policy for the period from 9.2.18
"We are very keen to do health. If we
The NSO report is based on the to 8.2.19. In May 2018, he felt abdomi-
can do short-term health, indemnity in
payroll data of new subscribers of nal pain and was admitted to the In-
particular, we would be very keen to
various social security schemes run stitute of Liver & Billiary Sciences,
do that. As a life company, we can al-
by ESIC, the Employees' Provident Vasant Kunj, New Delhi.
ready do longer-term health with fixed
Fund Organisation (EPFO) and Pen-
Thereafter conducting the necessary benefits, and this year we will do more
sion Fund Regulatory and Develop-
tests, the doctor found a liver infection of that," Tata AIA MD & CEO Naveen
ment Authority (PFRDA).
and the complainant remained admit- Tahilyani said.
12 July 2023 The Insurance Times