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Challenges in Indian Insurance Claims

This document discusses the Indian insurance sector and the challenges of claims settlement. It provides background on the privatization of insurance in India in 2000 and the establishment of IRDA as the regulatory body. The study aims to assess challenges in settling claims related to risks like deaths, maturities, surrenders, and annuities/pensions. It focuses on problems faced by insurance company employees in authenticating claims from customers. Key figures on life insurance claims amounts from 2019-20 to 2020-21 for LIC and private insurers are also presented.

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0% found this document useful (0 votes)
58 views4 pages

Challenges in Indian Insurance Claims

This document discusses the Indian insurance sector and the challenges of claims settlement. It provides background on the privatization of insurance in India in 2000 and the establishment of IRDA as the regulatory body. The study aims to assess challenges in settling claims related to risks like deaths, maturities, surrenders, and annuities/pensions. It focuses on problems faced by insurance company employees in authenticating claims from customers. Key figures on life insurance claims amounts from 2019-20 to 2020-21 for LIC and private insurers are also presented.

Uploaded by

Happy Sinha
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Abstract

India’s insurance sector has been growing dynamically in the last couple of
years especially since its privatization in year 2000.
The purpose of this study is to assess the challenges faced by insurance
industry while settlement of claims. Study includes the research work to be
done in the risk prone areas like claims settlement, maturity payments to legal
heirs, early death claims, surrender/withdrawal of policies, annuities/pensions.
In the Indian scenario these areas are very important and it’s the topic of study
because it includes the risk of payment being done to authentic person.
The study thus focuses on these key aspects and problems faced by field
executives, central teams of Insurance companies while settlement of claims
and for the front desk officers while receiving requests from walk-in
customers.

Keywords: Insurance, Annuities, IRDA, NAV, Lock-in period.

Introduction
Indian insurance sector got its’ life in actual sense in year 2000 with the
privatization of insurance sector. This all became possible following the
recommendations of the Malhotra Committee report, in 1999 and
because of this the Insurance Regulatory and Development Authority
(IRDA) was constituted as an autonomous body to regulate and develop
the insurance industry. The IRDA was incorporated as a statutory body
in April, 2000. The key objectives of the IRDA include promotion of
competition so as to enhance customer satisfaction through increased
consumer choice and lower premiums, while ensuring the financial
security of the insurance market.
Life Insurance sector plays a very important role in providing tax benefits
to individuals especially at the end of financial year people often go to
purchase policies.
Due to privatisation many private players came in market with the aim of
providing better services to customers.
Indian Insurance Sector
IRDA is the supervisory and controlling body of insurance sector in India.
Insurance Regulatory and Development Authority of India (IRDAI), is a
statutory body formed under an Act of Parliament, i.e., Insurance
Regulatory and Development Authority Act, 1999 (IRDAI Act 1999) for
overall supervision and development of the Insurance sector in India.
The powers and functions of the Authority are laid down in the IRDAI
Act, 1999 and Insurance Act, 1938. The key objectives of the IRDAI
include promotion of competition so as to enhance customer satisfaction
through increased consumer choice and fair premiums, while ensuring
the financial security of the Insurance market.
The Insurance Act, 1938 is the principal Act governing the Insurance
sector in India. It provides the powers to IRDAI to frame regulations
which lay down the regulatory framework for supervision of the entities
operating in the sector. Further, there are certain other Acts which
govern specific lines of Insurance business and functions such as
Marine Insurance Act, 1963 and Public Liability Insurance Act, 1991.
As of now, Life insurance industry comprises 24 insurers in India.
List includes,
Life insurance corporation of India
HDFC Life Insurance company LTD.
Max Life Insurance company Ltd.
ICICI Prudential Life Insurance company Ltd.
Kotak Mahindra Life Insurance company Ltd.
Aditya Birla Sun Life Insurance company Ltd.
TATA AIA Life Insurance Company Ltd.
SBI Life Insurance Company Ltd.
Exide Life Insurance company Ltd.
Bajaj Allianz Life Insurance Company Ltd.

Indian Life Insurance sector provides a wide range of products in both ulip and
non-ulip categories.
ULIP being a market linked plan vary according with market fluctuations.
Changed NAV plays a very vital role in changing ulip returns.
Nowadays even customers are very well aware with NAV’s and they visit
branches frequently to get to know about fund performance.
In the second quarter of year 2010 ulip lock-in period raised to 5 years from 3
years which brought major change in selling of ulip products in market
insurance and also became very tough from the sales point of view.
Claims of Life Insurers (₹crore)
S. LIC Private Sector Total
Insurer
No. 2019-20 2020-21 2019-20 2020-21 2019-20 2020-21
1 Death Claim 17,505.36 23,878.62 12,288.51 18,079.81 29,793.87 41,958.43
2 Maturity 1,51,159.70 1,65,659.20 21,348.71 25,845.12 1,72,508.41 1,91,504.32
Surrender/
3 70,148.12 80,101.00 47,117.12 49,315.89 1,17,265.24 1,29,416.88
Withdrawal
Annuities/
4 13,015.29 14,571.36 949.42 1,406.32 13,964.71 15,977.68
Pensions
5 Others 932.15 911.63 17,002.32 19,003.52 17,934.47 19,915.15
Total 2,52,760.62 2,85,121.81 98,706.08 1,13,650.66 3,51,466.70 3,98,772.47

Source: Taken from Annual Report IRDA 2020-21

Death Claim
30,000.00

25,000.00 23,878.62

20,000.00
17,505.36

15,000.00

10,000.00

5,000.00

0.00
2019-20 2020-21
LIC
Death Claim

12,288.51

18,079.81

Private Sector 2019-20 Private Sector 2020-21

Common questions

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There is a significant relationship between policyholder behavior and changes in regulatory measures such as the lock-in period for ULIPs in the Indian insurance sector. When the lock-in period for ULIPs was increased from 3 to 5 years, it led to a shift in consumer behavior due to the extended commitment required. This regulatory change made ULIPs less attractive to short-term investors, compelling insurers to position these products as long-term wealth accumulation strategies. The shift encouraged consumers to consider the long-term financial benefits and performance stability of their investments rather than seeking immediate returns .

Net Asset Value (NAV) plays a critical role in the performance and appeal of ULIP (Unit Linked Insurance Plan) products as it directly reflects the market value of the investments contained within the insurance plan. The NAV fluctuates with market conditions and is a key determinant of the returns on these investments, making it a pivotal element for investors considering ULIPs. Indian consumers have become increasingly knowledgeable about the significance of NAV, regularly visiting branches to inquire about the performance of their ULIP funds, signifying an awareness and engagement with investment-linked insurance products .

The Indian life insurance sector significantly contributes to the financial planning of individuals, particularly at the end of the financial year, by providing tax benefits that can be leveraged to reduce taxable income. Life insurance policies often qualify for deductions under sections of the Income Tax Act, thus encouraging individuals to purchase policies to optimize their tax liabilities. Additionally, life insurance products offer a combination of investment and protection, helping individuals plan for future financial needs while ensuring security for their beneficiaries .

The increase in the ULIP (Unit Linked Insurance Plan) lock-in period from 3 years to 5 years brought a major change in the selling of ULIP products in the Indian insurance market. This change made it more challenging from a sales perspective, as the extended lock-in period potentially reduced the attractiveness of these plans to consumers who preferred shorter investment commitments. The raised lock-in period required insurers and agents to adjust their strategies in marketing and persuading consumers of the long-term benefits of such investment-linked products .

The Indian insurance industry faces several challenges in the settlement of claims, notably in ensuring that payments are made to the authentic persons due to the risk of fraud. The most risk-prone areas include maturity payments to legal heirs, early death claims, surrender/withdrawal of policies, and annuities/pensions. These areas require careful validation and processing to prevent fraudulent claims and incorrect payments. This makes it crucial for field executives, central teams of insurance companies, and front desk officers to thoroughly verify claims and the identities of claimants .

Privatization significantly transformed the landscape of the life insurance industry in India by introducing competition and improving service quality. On the positive side, privatization led to greater consumer choice and competitive pricing, which enhanced customer satisfaction. Private players brought innovation and efficiency to the sector, offering diverse products tailored to customer needs. However, challenges also arose, such as the risk of mis-selling and the need for stringent regulation to ensure fair practices. Privatization necessitated robust governance to maintain financial security and protect consumers from potential exploitation by profit-focused entities .

The Insurance Regulatory and Development Authority of India (IRDAI) promotes competition within the insurance sector by overseeing the entry of various private players, which provides consumers with increased choices and competitive premiums. Its regulatory framework ensures that these entities operate within a safe financial security environment, ultimately benefiting consumer satisfaction through quality service and fair pricing. The IRDAI also enforces transparency and accountability across the industry, enhancing consumer confidence and trust. This comprehensive oversight is bolstered by laws such as the Insurance Act of 1938 and the specific regulatory authority given by the IRDAI Act of 1999, mandating the IRDAI to foster a competitive yet stable insurance market .

The Insurance Regulatory and Development Authority Act of 1999 differs from the Insurance Act of 1938 primarily in its focus on modernizing and adapting the regulatory framework to accommodate a competitive insurance market post-privatization. While the Insurance Act of 1938 laid down the foundational legal structure for insurance practices, the IRDAI Act established the Insurance Regulatory and Development Authority of India (IRDAI) as a statutory body to specifically oversee market competition, consumer choice, and premium regulation. The IRDAI Act was designed to enhance consumer satisfaction and ensure financial security, which was increasingly necessary with the entry of private insurers and a more dynamic insurance landscape .

The key motivations behind the privatization of the Indian insurance sector were to enhance customer satisfaction through increased consumer choice and lower premiums while ensuring the financial security of the insurance market. This was facilitated by promoting competition in the industry. The Insurance Regulatory and Development Authority of India (IRDAI) became instrumental in regulating this sector following the recommendations of the Malhotra Committee report in 1999. The IRDAI was constituted as a statutory body under the Insurance Regulatory and Development Authority Act of 1999 to supervise and develop the insurance sector .

The Insurance Act, 1938 is highly significant in the governance of the Indian insurance sector as it serves as the principal legislation providing the framework within which the Insurance Regulatory and Development Authority of India (IRDAI) operates. This Act empowers the IRDAI to create regulations that supervise and control the insurance entities, ensuring their operations comply with best practices for security and consumer protection. The act facilitates the regulation of life, general, and other specialty insurance segments, underlining the importance of structured and fair insurance practices in India .

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