Covid experience and Insurance Industry

COVID 19, a global pandemic, will go down in history as one of the deadliest disasters of the modern era. As of December 2021, 280 million people have been victims of this notorious virus, out of which more than 5 million have died so far....

ECG Limb Lead Reversal: Incidence & Impact on Insurance Underwriting

Innocuous lead reversals during ECG (pre-issuance medicals) can be deceptive and cause difficulties for the insurer in decision making causing acceptance of high-risk...

Mental Health Cover in Insurance

An ever-ongoing debate (in the grapevine) is on in the Indian insurance industry on ‘whether to cover mental health in health insurance or not?’ Of course, Of course, similar debates...

Cloud-based Medical Intelligence To Contain Health Insurance Fraud

Applying data analytic algorithms on conclusion(s) of both concurrent and post facto clinical audit conducted on life and health claims revealed that...

Myth vs Fact #9

Most of Acute febrile illness patients, can be comfortably managed on domiciliary management. A spike of 1030F temperature is not a criteria for hospitalization. Only patient’s requiring vital organ support viz. Bipap/ Ventilator/ Inotropes/ dialysis & patients with altered sensorium need ICU admission As they are labelled ‘Viral fevers’ – they do NOT need any antibiotics.

Myth vs Fact #8

Covid displaced usual chart-toppers heart attack and cancer to become the leading cause of death in the city in 2020. Out of 1.1 lakh total deaths recorded in the first year of the pandemic, 11,105 (10%) were Covid fatalities, 8,576 (7.6%) were cancer deaths and 5,633 (5%) were heart attacks, according to recent data accessed.

Myth vs Fact #7

Corona has been around for over 2 centuries and it is not going anywhere sooner! Like all viruses, Corona also is mutating - and continuously!! The SARS-CoV-2 virus has mutated over time, resulting in genetic variation in the population of circulating viral strains over the course of the COVID-19 pandemic.

Myth vs Fact #6

The quest of, “Inclusion of mental illness in Health Insurance” has perturbed the insurance industry by raising concerns with regards to it’s potential of fraud and measurability. Defining factors and societal rules ease out these concerns.

Myth vs Fact #5

Despite the race of offering unique cover in health insurance, insurers are some how wary of offering cover for mental illness. The common fear/ concern is of abuse. It seems there is comfort in having an umbrella of denying all claims relating to psychological complaints/ ailments. Truth is something different.

Myth vs Fact #4

With barely 5-7% cases being repudiated, the common perception is against the insurer...

Myth vs Fact #3

There are multiple levels of adjudication before an insurer decides to repudiate a case. Despite such diligence there is always a worry whether this would jeopardize their reputation and should it go to a legal forum, the decision may be against them. Let us shatter this myth.

Myth vs Fact #2

Insurers many a times faces challenges because they live with a myth that, “Insurer cannot question the doctor in case a clarification is needed for rational decision making and no avenue if they choose to not reply”.
But is it true?

Myth vs Fact #1

Medical management claims, in reimbursement stage, are more prone for abuse as it is felt that all dengue patients need admission & antibiotics need to be administered. The catch question that comes is, “What is the patient’s fault?"

Case Study #8

Pre Covid 19 pandemic the insurers were getting adept at managing abuse/ fraudulent claims in cases like acute febrile illness, gastroenteritis, dengue, and malaria. Using high ended antibiotics even for viral ailments was rampant in inflating the bills.....

Case Study #7

“Utmost Good Faith “is one of the basic principles which makes Insurance different from other legal contracts. It requires life to be assured to disclose all material facts related to income, occupation, lifestyle & personal medical history while making an insurance application and the insurance company to disclose all the benefits, terms and conditions of the product being applied for.......

Case Study #6

We get to see a lot of “High Value” & “High Networth” cases these days. The definition of High Value could be anything beyond sum assured of Rs 5 Crores and High Networth could be an applicant who is paying more than Rs 2 Lakhs premium per annum. The criteria may vary from insurer to insurer......

Case Study #5

The reason why underwriting is exciting in its own way is because of the uniqueness of each proposal that an underwriter evaluates. They often say that learning for an underwriter never stops until the last day of his work & the last case that he underwrote. This case study is an example of such a unique learning experience.....

Case Study #4

The first-generation underwriters will always say that underwriting is not only assessment of medical, financial, occupation or avocation risk, it is assessing the risk as a whole. It’s not probing at each aspect of risk in silo, it’s about collating multiple data points to create a pen picture of the risk and taking a decision....

Case Study #3

In a global context, whenever we talk about Life Insurance Underwriting, inadvertently the focus is on medical underwriting. In some markets, the aspects of group underwriting or High Net worth underwriting has gained importance. In India, the focus is widespread and encompasses additional aspects like Fraud, Risk Scoring Matrix, Financial Underwriting and Surrogates Analysis...

Case Study #2

As, Covid Pandemic has resulted in mass sufferings and pains to the masses; for the insurance sector it has generated massive revenue loss. The losses were compounded by fraud and abuse perpetrated both by consumers and provider. INCHES was instrumental in helping insurers face these fraudulent activities and save several crores of Rupees.

Case Study #1

ADengue has been a debatable topic w.r.t. a mosquito bite being considered accident and many policies overseas exclusively cover infections due to mosquito bites under a special clause in PA policies.
But in India, where the PA policies do not mention such specific clauses, are claims of dengue yet payable?

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