Debashish Dutta

The main reasons for rejection of insurance claims in motor and health insurance in India include: Motor Insurance: 1. *Invalid or lapsed policy*: If the policy has expired or is no longer valid, claims will be rejected. 2. *Driver's license and RC issues*: If the driver's license or vehicle registration certificate (RC) is invalid or not up-to-date, claims may be rejected. 3. *Accident caused by unauthorized driving*: If the vehicle was being driven by someone not authorized by the policyholder, claims may be rejected. 4. *Wear and tear*: Claims for damage due to normal wear and tear may be rejected. 5. *Contributory negligence*: If the policyholder is found to be partially responsible for the accident, claims may be reduced or rejected. Health Insurance: 1. *Pre-existing conditions*: Claims for pre-existing conditions may be rejected if not disclosed at the time of policy purchase. 2. *Non-disclosure of medical history*: Failure to disclose medical history or hiding information may lead to claim rejection. 3. *Exclusions and limitations*: Certain treatments or conditions may be excluded or have limitations, leading to claim rejection. 4. *Non-network hospitals*: Claims for treatment at non-network hospitals may be rejected or require additional approval. 5. *Lack of documentation*: Incomplete or missing medical records and bills may lead to claim rejection. #irdai the contribution percentage wise as per policy bazaar is given below -

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#MuchNeeded #AffordableInsurancePremium #Insurance #Premium #IRDAI #InsuranceIndustry 🟨👉 The Insurance Regulatory and Development Authority of India (#IRDAI) has directed insurance companies to make insurance products more affordable. This directive is part of IRDAI's vision of achieving 'insurance for all' by 2047. 🟨👉 Rising #premiums are making essential coverage out of reach for many, especially the elderly. Insurance Regulatory and Development Authority of India

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Take a look at my article on Democratising Insurance Access in Bharat featured in ETBFSI. As we work to bridge the insurance gap across India, technology and localized distribution models are crucial in reaching the heart of Bharat – beyond urban centers to tier 2, tier 3, and rural areas. The article explores how digital innovations, combined with on-ground agents, empower people in these regions to access, understand, and choose the right insurance solutions. At PBPartners, this mission resonates strongly as we continue expanding our local presence and leveraging tech to bring insurance within everyone’s reach. A big thanks to the ETBFSI team for spotlighting this crucial topic! Here’s to building a more inclusive and insured Bharat. #InsuranceForAll #Bharat #FinancialInclusion #PBPartners #DigitalTransformation https://lnkd.in/geB-Bbbc

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Draft circular by the Insurance Regulatory and Development Authority of India (IRDAI) aimed at reducing insurance fraud. Key points include: 1. Background checks for agents and intermediaries. 2. Monitoring performance and business trends. 3. Identifying four types of fraud: internal, distribution, policyholder, and external. 4. Implementing fraud risk management strategies. 5. Establishing a Fraud Monitoring Committee. 6. Developing 'Red Flag Indicators' for fraud detection. 7. Educating policyholders about insurance fraud consequences. 8. Collaborating with the Insurance Information Bureau. The goal is to curb instances of fraud and enhance the insurance industry's integrity. https://lnkd.in/gSuQAiDZ

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Profit and Loss Analysis of All General Insurers Over the Last 3 Years Profitable Insurers:- ECGC Ltd has the highest profit across the three fiscal years (2023-24: ₹2,159.05 crores). ICICI Lombard, Bajaj Allianz, and New India Assurance have also shown consistent profits over the three years. Loss-Making Insurers:- United India Insurance Co Ltd and National Insurance Co Ltd have incurred significant losses across all three fiscal years.The Oriental Insurance Co Ltd also shows continuous losses, especially substantial in 2022-23. Fluctuations:- Some insurers, like IFFCO-Tokio and Navi General Insurance, show significant fluctuations, indicating potential instability in performance. General Trend:- Most government-owned insurers tend to show poor performance, often incurring losses, while private insurers generally show healthier financials. #Generalinsurance #healthinsurance

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#Generalinsurance industry recorded an annual premium of close to Rs 2.9 lakh crore for FY24, marking a 13% rise from the previous fiscal year's Rs 2.6 lakh crore. #Five standalone #health #insurance companies saw a significant 26.2% increase in total premium, climbing from Rs 26,243 crore to Rs 33,115 crore during the same period. #Standalone health insurance companies' growth can be credited to #larger #policy sizes, as they introduce #high-value #policies worth crores. Premium rates have been adjusted to match #medical #inflation, and coverage has expanded. #Irdai's FY23 report by Emkay Finance shows retail health insurance premiums grew steadily at 20% CAGR from FY12-19. However, between FY19-23, the premium growth rate slowed slightly to 19%, while coverage expansion was limited, with only a 5.9% increase in the number of #insured individuals. The growth was mainly driven by #price and #sum assured adjustments. In the 11 months leading up to Feb 2024, health insurance premium reached Rs 98,716 crore, a 20% rise from last year's Rs 81,997 crore. This figure encompasses health premium from general insurers and SAHI companies, with health insurance's share for this period increasing to 37.5% from 35.2% in the previous year. Two new players, #Galaxy Health and #Narayana Healthcare, enter the health insurance market alongside #Star Health, as per V Jagannathan and Surgeon Devi Shetty. While health insurance premiums are on the rise for most general insurance companies, #slower growth in segments like #motor is holding back their overall performance, #Specialized #insurance sectors, particularly #Agriculture Insurance Company #AIC and #ECGC, have contributed to the non-life industry's #sluggish growth this year. #Agriculture insurance witnessed a significant 32% decline in premiums, falling from Rs 14,619 crore last year to Rs 9,919 crore.

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Looking at numbers : Development in fire premium after opening of insurance sector 2000-2024 Continuing my posts under the heading  “Looking at the numbers “ the table above gives detail of fire premium , its contribution in total industry premium and co-relation with #GDP of India. In the financial year 2000-01 the fire premium of Rs.2096 Crores, accounted for 21.05% of industry premium. Over the period of 24 years , the industry premium has multiplied 30 times, the GDP has multiplied 17 times but fire premium has increased only 12 times. The de-tariff regime from 2007 resulted in decline in fire premiums; since then, there have been periods of indiscretion and discipline both . The fire premium growth has been much less than GDP growth; a detailed analysis will help the industry. The share of fire premium declined from 21.05% in 2000-01 to 8.86% in 2023-24. As fire premium is key to profitability, look forward to your comments for analysis and informed discussion.

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🚨 IRDAI's New Directives: A Game Changer for Retail General Insurance Claims! 🚨 As an insurance professional in India, I am excited to see the transformative steps IRDAI has taken to enhance customer service and streamline claims processing in the general insurance sector. Here are the key highlights: 1. No Claim Rejection for Document Deficiency: All required documents must be collected at underwriting. Claims can't be rejected for missing documents at the claim stage. 2. Swift Claim Decisions: Insurers must decide on claims within 7 days of receiving the survey report. Delays could result in penalties. 3. Minimal Customer Burden: Customers only need to submit essential documents at claim time. For partial losses, insurers will handle salvage disposal. 4. Transparent Timelines: Insurers must publish turnaround times for various processes on their websites, ensuring transparency and accountability. 5. Flexibility and Innovation: The shift to principle-based regulations encourages best practices, innovation, and faster response to market dynamics. 6. Parametric Products: Claim settlements can be based on specified loss occurrences, simplifying the process and reducing evaluation time. 7. End-to-End Tech Solutions: Insurers must implement technology solutions for seamless policyholder onboarding, servicing, renewals, and claim settlements. 8. Flexible Cancellations: Policyholders can cancel policies anytime without providing reasons. Insurers can cancel only for fraud or misrepresentation with a 7-day notice. These changes are set to revolutionize the insurance landscape, making it more customer-centric and efficient. It's a significant move towards protecting policyholder interests and enhancing the overall insurance experience. #Insurance #IRDAI #CustomerService #ClaimsProcessing #Innovation #Transparency #India https://lnkd.in/dSXv-Z-4

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Despicable #Piracy of an world acclaimed book on Marine Insurance I joined General Insurance industry in September 1981. I belong to the 5th batch of Direct Recruits of National Insurance Company, Calcutta (Now Kolkata). In my Direct Recruit batch there were many interesting intelligent people. Those days a monthly salary of Rs 1641/ was indeed princely and it attracted very good talent. One such great talent was my batchmate KS Vishwanath. Unlike me, he was a serious and intense person. He was very much in love with Sitar and wanted to be a disciple of top names in Hindustani Sitar vaadan. But he had some fibromyalgia issues that frustrated his attempts to gain mastery over Sitar. My dear friend and batchmate Vishwanath stepped into Marine Technical in Head Office in 1982 and after that what happened was history. Vishwanth drowned himself in the ocean of Marine Insurance, both Cargo and Hull. His single-minded focus steered him through the choppy waters of the complex world of marine insurance and he emerged as the undisputed authority of Marine Insurance in National Insurance. He was a much sought after faculty in the National Insurance Academy and after his stint in Singapore, he went on to be acknowledged as an international expert on Marine Insurance. The result of his 'tapasya' was a phenomenal book on Marine Insurance published by the highly prestigious "Witherbys" of London; a book which won critical acclaim in the world arena of marine insurance. Indian Insurance Industry ought to celebrate this great academic achievement of an Indian whose book is held in great respect in the mecca of marine insurance, London. Now the anti-climax. I heard from KS Vishwanath that his book is being photocopied blatantly without permission and used by people in the marine departments of big insurance companies in India who are tight fisted about spending a few thousands of rupees buying copies of his book legally and are resorting to this daylight piracy. Highly shameful and reprehensible behaviour. My friend KS Vishwanath has a great humanitarian side to him and he is quietly engaged in helping the cause of hapless children. I Know, Vishwanath does not run after money and glitter. Hence it is not the personal economic loss to him that matters but the fact that the royalty he gets from the sale of his books internationally, helps him fund his highly laudable philanthropic acts for needy children, and that being stymied by these acts of book piracy, makes me livid with anger, at this low level of ethics in our so-called big insurance companies and executives. I earnestly request my insurance industry professionals to take it up personally to police and stop this unauthorised photocopying of my friend's great book on Marine Insurance. I expect the big insurance companies where all these photocopies are circulating to make amends by formally buying multiple copies of the book. That will be true "Prayaschitta" (atonement).

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New product innovation: The recent event of cyber attack on Ranveer Allahbadia’s YouTube channel brings into fore the lack of product innovation in the Indian general insurance market. There are cyber insurances and cyber insurances but they lack differentiation. This is true of many other products also. General Insurance started as a mechanism for physical asset protection, but the world has shifted from physical assets to digital assets. Insurances for digital protection are seriously lacking in the Indian market. Recently, I tried to get intellectual property insurance (IPI) for a client. My client was sued in Europe by someone saying that his design was copied by my client. The matter was eventually settled but the client nevertheless wanted to buy IP insurance, both for enforcement of IP as well as defence against breach of IP. However, I did not receive a quote from any Indian insurer. Buying directly from the international market, such insurances that Indian insurers don’t do is also not easy. One needs to get a certification from IRDA that the product doesn’t exist in the Indian market. This is required as per RBI for remittance of premium in foreign exchange to the overseas insurer for issuance of policy. I think there is too much diffidence amongst Indian general insurers to bring innovative products. If an insurer wants guarantee or assurance of profitability, sustainability and scalability, then I’m afraid no new product innovation can happen. Product performance depends on many market variables all of which cannot be ascertained beforehand. There is also an element of experimentation also involved.

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WazirX's new loss distribution plan is like an insurance policy where everyone pays the premium, but nobody gets the claim, and everyone loses !! For once insurers aren't the bad guys !! #unexpectedwin https://lnkd.in/dEY4379X

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The way insurance is sold in India is evolving, but are we prioritizing the right things? IRDAI’s concerns about bancassurance and our Finance Minister Nirmala Sitharaman’s powerful remarks at the SBI’s 11th Banking and Economics Conclave 2024 are a wake-up call for all of us. Banks, the backbone of financial stability, are now shifting their focus to selling insurance policies—often at the cost of customer trust. While bancassurance has undoubtedly helped increase insurance penetration, it's also opening doors to mis-selling and financial strain for unsuspecting customers. As someone who has been in the insurance industry for over two decades, I strongly believe that the essence of both banking and insurance lies in trust. Once lost, it’s incredibly difficult to regain. Don’t miss this blog that dives deep into this critical issue. It’s a must-read for everyone—whether you're a professional in the financial sector or a customer navigating the maze of financial products.

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IRDAI’s new detariff guidelines are a game changer, they offer insurers the flexibility to tailor products according to the consumer needs. However, I believe IRDAI’s decision to keep motor third-party insurance regulated is crucial. It protects consumers from sudden price hikes, ensures affordability, and maintains market stability. This balance is necessary to protect policyholders from market volatility and ensure standardized policy terms. To read more about the guidelines, check out the blog👇

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Why do people have insurance fraud in india? Financial Gain:The primary motive for insurance fraud is monetary benefit. People see it as a quick way to get money, especially during financial hardships. For instance, they may exaggerate damages after an accident or file false claims for injuries that didn’t happen to receive a higher payout. Low Awareness of Legal Consequences:Many individuals engaging in insurance fraud may not fully understand the legal consequences of their actions. They might believe that the penalties for being caught are not severe, or that they can easily get away with fraudulent activities without facing legal repercussions. Opportunity:In many cases, individuals take advantage of a situation where there’s an opportunity to commit fraud. For example, after a minor accident, they might work with repair shops to inflate the cost of repairs or fabricate damages that weren’t caused by the incident. Perception of Insurance as "Fair Game":Some people view insurance companies as faceless, wealthy entities, and they justify fraud as being "victimless." They believe that insurance companies can easily absorb the financial losses or that they deserve to exploit them for the high premiums charged. Collusion with Service Providers:In some cases, fraudsters work with repair shops, doctors, or even insurance agents to inflate claims. High Cost of Vehicle Repairs:Due to the high costs of car repairs and medical treatment following accidents, individuals might be tempted to exaggerate claims to recover more than the actual cost. Organized Fraud Rings:In some cases, insurance fraud is committed by organized crime groups. These fraud rings stage accidents, create fake policies, and file multiple claims across different insurers. Such groups exploit loopholes in the system to make large profits from fraudulent activities. Delay in Claim Settlements:The slow processing of legitimate claims by some insurance companies can lead to frustration among policyholders. In retaliation, some may engage in fraudulent activities, feeling justified in inflating their claims to "compensate" for the delays. Desperation in Financial Emergencies:Individuals facing personal financial crises may resort to insurance fraud out of desperation. Filing a fraudulent claim may seem like an easy way to deal with debts, medical bills, or other urgent financial needs. Lack of Robust Fraud Detection Systems:Some people commit fraud because they believe the chances of getting caught are low. Inadequate fraud detection mechanisms and loopholes in the insurance system make it easier for individuals to exploit the system without fear of immediate consequences. Cultural Factors and Social Norms:In some regions, engaging in minor fraudulent activities is socially accepted or seen as a way to "beat the system." This can contribute to a mindset where insurance fraud is viewed as a low-risk, high-reward activity.

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Breaking News: Maharashtra Government Cancels ₹3,000 Crore Insurance Contract! The Maharashtra government has terminated its contract with United India Insurance (UII) for the state's flagship health insurance scheme, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), due to unsatisfactory performance ¹. *Key Highlights:* - _Contract Termination_: ₹3,000 crore contract cancelled due to unsatisfactory response from UII. - _Reason_: Unsatisfactory performance in implementing the health insurance scheme. - _Alternative Plan_: State government to implement universal health coverage on its own without involving insurers. - _Central Government Contribution_: 60% of premium, with state government paying the balance. This development is significant, as MJPJAY 2.0 aimed to provide universal health coverage to all state residents with valid ration cards and domicile certificates. #HealthInsurance #MaharashtraGovernment #MJPJAY https://lnkd.in/gFERnZ4M

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Competition in the insurance sector is about to heat up! The Indian government is set to initiate an offer for sale (OFS) of its 7% stake in General Insurance Corporation of India (GIC Re) on Wednesday, Here are the key details: - 5.95 crore shares will be sold, with an option to sell an additional 5.95 crore shares - Floor price set at ₹395 per share, a 6% discount to the current market price - Total OFS size estimated at ₹4,701 crore This marks the first stake reduction since GIC Re's IPO, and will bring the government's holding down to 78.78%. #GICRe #InsuranceSector #Disinvestment #OFS https://lnkd.in/gBH4pnjd

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