annual report 2009-10 - IRDA

ANNUAL REPORT 2009-10I.4.6.13 The Authority actively continued to engagewith various industry bodies and stakeholders, with aview to further streamlining the health insuranceservices in the country. Particularly with reference tothe functions of TPAs, certain formats and documentsfor communication and processing are proposed forstandardisation to bring in uniformity and to smoothenthe processes. A number of measures aimed atimproving the customer service orientation of theindustry as well as to improve transparency in thesystem were initiated during 2009-10.I.4.6.14 The Authority maintains a separate systemfor handling grievances with respect to TPAs frompolicyholders, providers and other stakeholders.During 2009-10, the Authority received 312complaints, of which 305 were disposed and 7complaints were outstanding as on 31 st March, 2010.TABLE 48THIRD PARTY ADMINISTRATORS - CLAIMS DATAYear Claims* Claim Settled ClaimsReceivedOutstandingWithin one Within 1-3 Within 3-6 More thanmonth months months 6 months2008-09 2446713 1847212 360173 61022 12934 185120(75.50) (14.72) (2.50) (0.53) (7.57)2009-10 3365940 2348147 597408 121485 29362 299381(69.76) (17.75) (3.61) (0.87) (8.89)Note: Figures in bracket indicate ratio (in per cent) of claims settled to the total claims received.*Excluding as on 31 st March.4.7 BUSINESS IN THE RURAL AND SOCIALSECTORI.4.7.1 The Regulations framed by the Authority onthe obligations of the insurers towards rural and socialsectors stipulate obligations to be fulfilled by insurerson an annual basis. The regulations require insurersto underwrite business based on the year ofcommencement of their operations. ‘For meeting theseobligations the regulations further provide that if aninsurance company commences operations in thesecond half of the financial year and is in operationsfor less than six months as at 31 st March of the relevantfinancial year (i) no rural or social sector obligationsshall be applicable for the said period; and (ii) theannual obligations as indicated in the Regulations shallbe reckoned from the next financial year which shallbe considered as the first year of operations for thepurpose of compliance. In cases where an insurancecompany commences operations in the first half ofthe financial year, the applicable obligations for thefirst year shall be 50 per cent of the obligations asspecified in these Regulations.’Obligations of life insurers:Rural Sector ObligationsI.4.7.2 All the twenty two life insurance companies inthe private sector fulfilled their rural sector obligationsduring 2009-10. The number of policies underwrittenby them in the rural sector as a per cent of the totalpolicies underwritten in the year 2009-10 was as perthe obligations applicable to them.I.4.7.3 LIC was compliant with its obligations in therural sector, and underwrote a higher per cent ofpolicies in rural sector, than the prescribed 25 per centfor 2009-10.Social Sector ObligationsI.4.7.4 Out of the twenty two life insurance companiesin the private sector, except HDFC Standard, all theother companies fulfilled their social sector obligationsduring 2009-10. The number of lives covered by themrespectively in the social sector was above thestipulated obligations.I.4.7.5 HDFC Standard which was in its 10 th year ofoperations in 2009-10, covered 50,268 lives in thesocial sector as against the obligation of 55,000 lives48