Publications

Recent blog

How can an insurer question the doctor/line of management?

Insurance companies are facing challenges- high pending cases, high claim ratios and paying crores of rupees just because doctor(s) won’t answer the query raised or the insurer does not raise a query holding the longtime myth of, “An insurer cannot question the treating doctor and the line of treatment given".

Posted On: 31th Jan 2019

Recent whitepaper

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 ....

Posted On: 19th Jan 2019

Recent myth vs fact

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.

Posted On: 12th Feb 2019

Recent case study

Case Study #1

Dengue 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?

Posted On: 16th Mar 2019

How can an insurer question the doctor/line of management?

Insurance companies are facing challenges- high pending cases, high claim ratios and paying crores of rupees just because doctor(s) won’t answer the query raised or the insurer does...

Posted On: 31th Jan 2019

Changing your Insurance product structure? Time to be CAREFUL!!!

Policy structures seldom change but when it changes, it results in a pool of challenges for the insurers- satisfy the regulator on one hand as well as ensure self-protection via a medical, legal...

Posted On: 27th Dec 2018

Repudiated Insurance Case at a Legal Forum

An insurer repudiates a claim only after scrutinizing proper policy documents and analyzing whether it is rational. But despite that some grievances against the insurer reach the legal forum whose...

Posted On: 20th Dec 2018

Pending Cases: D-JFM Scourage

December in geographies following Jan-Dec financial year and JFM quarter in India are crucial for the insurance industry; being the closing of the financial year. Industry operates under twin...

Posted On: 13th Dec 2018

Medical Management

50-60% of death claims and 100% of health claims need prudent review of the clinical data for a well-informed decision. Unfortunately Claims Management is discussed in the context of administrative...

Posted On: 29th Nov 2018

Demystifying Chronic Kidney Disease

Singapore has a national subsidised dialysis programme since 1996. Thailand provides subsidy for haemodialysis since 2013 under aegis of NHSO. In 2016, Indian…

Posted On: 22nd Nov 2018

Profile of a Fraudster

Why do people commit fraud?
One or more of the following three variables are usually evident in any proven instance of insurance fraud. In large percentage of such claims more than one exists as...

Posted On: 15th Nov 2018

Technology disruption in Insurance Risk Management

Why should rising health claim be a surprise? Some or more of the factors are in play; some affect all insurers and others are insurer specific....

Posted On: 8th Nov 2018

Insurance Fraud - A Global Malaise

Across the globe, health insurance is a tool that gives millions of people access to quality healthcare without burning a hole in their pockets. Patients, from those seeking...

Posted On: 1th Nov 2018

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...

Posted On: 19th Jan 2019

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...

Posted On: 13th Dec 2018

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...

Posted On: 14th Feb 2019

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.

Posted On: 12th Feb 2019

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.

Posted On: 24th Jan 2019

Myth vs Fact #4

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

Posted On: 17th Jan 2019

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.

Posted On: 10th Jan 2019

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?

Posted On: 3rd Jan 2019

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?"

Posted On: 20th Dec 2018

Case Study #1

Dengue 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?

Posted On: 16th Mar 2019