Page 33 - The Insurance Times July 2020

mindful of these risks and understand the scope of the seen so far. The disease has pan-India spread and there is
relevant insurance. very real risk of it spreading exponentially. Treatment of
COVID-19 may need prolonged hospitalisation which could
Issues relating to workers' compensation be costly. Many people have some form of health cover, be
insurance policies: it corporate of personal health cover. However, as this virus
is new, there is a lot of confusion if corona cases would be
Workers' Compensation insurance covers your employees covered under existing health policies or not. To address the
who suffer injury or illness contracted in the workplace. This
extends coverage to injuries "arising out of or in the course concerns of the policyholders and to bring clarity on the
coverage of coronavirus, insurance regulator IRDAI came
of employment," meaning that claims for compensation
must allege work-related losses. Coverage, based on "work- up with guidelines for the insurance companies on March
relatedness," is analyzed based on the time the loss occurs, 4, 2020. The IRDAI guideline stated: "Where hospitalisation
is covered in a product, insurers shall ensure that the cases
the place where the loss occurs, the specific activity the
claimant was engaged in when the loss took place, and the related to coronavirus disease shall be expeditiously
handled."
specific nature of the loss. Thus, there would be a good
argument for coverage of a health care worker who Many health insurers came forward and clarified to their
becomes infected because of exposure to patients on the policyholders about the coverage of corona. However, on
job. In assisting employees with Workers' Compensation March 11, 2020 WHO notified COVID-19 as pandemic and
claims, it will be critical to make a prompt, careful record hence health insurers are no more obligated to entertain
of the time, place, and circumstances of the exposure.
defined benefit claim. Despite this there are many health
insurers like Aditya Birla Health Insurance, Bajaj Allianz
Some companies may see employment-related claims General Insurance and Edelweiss General Insurance who
related to injuries that are not covered by Workers' have come forward and clarified that they are still providing
Compensation insurance. For example, claims may be cover for coronavirus. This means the future course of
brought on behalf of family members who claim infection coronavirus will decide the level of challenge health insurers
brought home from the workplace, or contractors may claim will be facing.
for injuries contracted on a company's premises. Employers
Liability insurance may provide coverage in some instances. Since, it has been announced that if there are any claims
The best time to prepare for infectious disease exposures is due to coronavirus, wherein the case is of hospitalisation for
before they happen. That includes taking careful stock of your at least 24 hours, it will be covered under a health policy as
risk pathways and assessing all the insurance that may become per the contract. If things go out of control or claims grow
relevant. Pillsbury's Insurance Recovery and Advisory Team exponentially, this may impact insurance space hugely.
experienced crisis management professionals are closely However, with recent announcement of coronavirus as a
monitoring the global threat of COVID-19, drawing on the notified disaster, the cost for managing COVID-19 infected
firm's capabilities in supply chain management, insurance law,
cyber security, employment law, corporate law and other patients would be at the rates fixed by the state government
areas to provide critical guidance to clients in an urgent and / recent guidelines of GI Council stating the amendments
quickly evolving situation. on Proposed Hospital Service Charges vide their Circular
dated 20.06.2020, which may come as having cushioning
Health insurance to go through corona test: effect for everyone.
Health Insurance segment has been one of the brightest spot This may also be an opportunity for the health insurance
in the general insurance category. This is offered by both industry to prove its metal and win the trust of the
multi line general insurance companies and specialized prospective customers. In a high contagion scenario, the
standalone health insurance companies as well. Health ability of all insurers to speedily assess claims, detect
insurance premium through multi-line general insurance
fraudulent claims and disburse genuine payments under the
companies was Rs 46,774 crore till FYTD February 2020,
policies will go a long way in tempering the pandemic's
whereas standalone health insurance companies collected
a premium of Rs 12,560.96 crore during the same period. impact. We could expect a lot of co-operation between the
Taken together health insurance segment alone had a 34 IRDAI, insurers, network hospitals and intermediaries for
per cent share in the total business of the entire General standardization in COVID-19 claim settlements to meet
Insurance industry. these critical needs of the country. This event is likely to re-
enforce the need for a health cover which could be a positive
Corona is going to the biggest challenge the industry has note for Indian health insurance industry.

The Insurance Times, July 2020 33