N. Raghuraman’s column – One Wrong International Brings A Bad Name to the Entrere Industry | N. Raghuraman’s column: A wrong intention defames the entire industry

N. Raghuraman, Management Guru

Imagine, your relatives are hospitalized. After prescribing the doctor’s medicine slip, you are busy taking medicines from the hospital’s medical. All the bills are maintained, because later they want to claim insurance benefits. Bill of blood tests conducted in the hospital was also kept. The doctors gave your medicines and relatives soon got healthy and discharged. You returned home after taking a sigh of relief and 15 thousand rupees for hospital expenses. Started preparing for the application for refund of lower amount.

You are confident that these bills will be approved by the insurance company, because you have not raised any claim from purchasing insurance and have paid four and a half times the amount as a premium. But you were surprised when the company not only rejected the claim of hospital expenses, but also canceled your policy citing the process of processed and fraud.

Not only this, your name started appearing in the fraud alert database, which means that in future an insurance company will not insure you and if made, every claim will be seen from a fraud perspective. Surprisingly, where is the fraud done? To understand this, read the story of 29-year-old Veeresh Rathore of Bengaluru, who bought a group insurance policy from an insurance company in 2022 for his own and elderly parents.

In three years, he got Rs 67 thousand 606 to the company. Payed and not even taken any claim since then. In April 2024, his mother was admitted to the local Sharabhathi Hospital for the treatment of serious gastroenteritis. After discharging the mother from the hospital, Rathore submitted a repayment claim of Rs 14 thousand 500, which was rejected and her policy was also canceled, stating the following reasons.

1. The company alleged that broad spectrum antibiotic medicine (pipataz) was given without any culture sensitivity test.

2. Rathore allegedly bought 5 doses, while only three were used.

3. There is a lack of authentication of the doctor on the discharge details.

4. There were technician signs on blood reports, not pathologists.

Now tell you what is the role of your, mine or Rathore in the selection of antibiotics, earlier tests, documents in documentation? How can you expect them to know that they would know that test is necessary before giving a medicine? How can they expect that we would know what the discharge details look like or how should we check whether the report is signed by the technician or the pathologist?

Even more surprising is that the company canceled Rathore’s policy and issued an internal industry alert, calling him a fraudulent claim, which hurt his reputation and also affected the possibility of taking insurance in future. Rathore’s appeal was unanswered in the Insurance Regulatory and Development Authority and Insurance Lokpal. He then approached the Consumer Forum on 24 June 2024.

The company said that the complaint is baseless and these discrepancies are deliberately pointing to the rigging. But after examining the evidence, the Commission rejected the company’s arguments. On May 16, he ordered him to compensation of one lakh for mental pain, I am interest for dismissing the claim for mental pain, Rs 14,500, legal expenses Rs 10,000. Pay and pay 50 thousand rupees in the Consumer Welfare Fund as punitive compensation. Get deposited Instructed the insurer to issue a new insurance policy for the remaining period and renew later. He will also have to remove Rathore’s name from the fraud alert database.

Funda is that The bad intention adopted in a one -one process with a client can become a threat to the entire industry. Keeping clear intentions helps in the development of the industry.