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ANNUAL REPORT 2011-12
launched an exclusive website www.policyholder.gov.in
for insurance education. The user friendly and menu
driven website contains information in the simplest
possible language about IRDA, buying insurance, making
a claim, how to make a complaint under heading of
consumer complaint, etc. It also encompasses information
about the various initiatives taken by IRDA towards
consumer protection, Handbooks on insurance for most
common products providing details of coverage offered,
Frequently asked questions, Policyholder servicing Turn
Around Times (TATs), What to do in case of grievance,
etc. IRDA is encouraging all insurers and other
stakeholders to provide a link to IRDA Policyholder’s
education website in their respective website. It is
expected that visiting the IRDA’s website may help
consumers to be in a better position while purchasing
insurance products as per their requirements as well as
to understand their rights and responsibilities as
consumers of insurance products and services.
Claims Settlement and Fraud:
44. Insurers should take all steps to ensure that the
incidence of claim repudiation is reduced to the barest
minimum. To enable this to happen, they should adopt
measures to explain to the parties upfront, the exact
coverage and exclusions. If a claim has still to be
repudiated, they should explain the circumstances under
which the claim has to be rejected, either wholly or
partially, to the policyholder with empathy so that a
confrontation is avoided. Further, insurance companies
should put in place systems that ensure the consummation
of contracts after the nuances of the various terms and
conditions are explained to the prospect. The other side
of the coin of course is dealing fi rmly with attempted
frauds and not allowing any dilution in the terms of the
contract is another way of working towards achieving
healthy claims ratios. The Authority is presently working
on laying down the broad framework for prevention,
detection, classification, mitigation and reporting of
insurance frauds. The framework would also encourage
the insurance councils of life and non-life companies to
build up databases to serve as reference points for the
industry to share statistics and experience on frauds.
Insurers should ensure that there is in place an effi cient
mechanism to weed out fraudulent attempts so that claims
ratios are maintained within healthier limits.
Health Fraud Analysis:
45. The Authority has formulated a Health Insurance
Forum in February, 2012 taking representations from all
related fi elds including Non-life insurers, Life Insurers,
Standalone Health Insurance Companies, concerned
Ministries, National Accreditation Board for Hospitals and
Health Care Providers (NABH), Hospitals, Service
Providers, TPAs, CII, FICCI, etc. The objective of the
Forum is to aid, advise, and assist the Authority in further
improvements in health insurance, health provider
services and all health insurance related issues. The
purpose of the Forum includes initiatives by all stakeholders
in the health insurance and health service sector,
maintaining unifi ed approach by all stakeholders against
frauds, providing high service standards, adherence to
ethical standards and maintenance of business conduct
with protection of interests of policyholders and service
recipients. The Authority has also framed an exposure
draft on insurance for persons living with HIV/AIDs and
the same has been released for comments. The Authority
is carrying forward its discussions on major issues like
insurance for HIV people, cover for persons with
disabilities with the life and general insurance Councils.
The issues are also under discussion with the Government
of India, National AIDS Control Organisation (NACO), etc.
Transparency in the Advertisements released:
46. In order to enhance the transparency of life insurance
advertisements, the Authority vide its circular IRDA/LIFE/
MISC/CIR/129/08/2010 dated 16 th August, 2010 advised
all insurance companies to ensure that all insurance
advertisements should clearly identify the product as an
insurance product as well as state the availability of life
insurance coverage. In advertisements, where benefi t of
guarantee is highlighted, insurers are required to disclose
the conditions under which the guarantee operates. In
respect of Unit Linked Insurance Plans, insurers have
been mandated to disclose the actual asset mix of various
underlying funds on their respective web portals at least
on a half yearly basis so as to provide clear, actual and
timely information to the prospects.
Agent’s Training / Qualification:
47. The future success of the life insurance profession
depends, above all, upon the knowledge and integrity of
the people who advise customers – and are their fi rst,
and most important point of contact. At the IRDA, the
regulator’s goal is to see that life insurers are increasingly
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