ET BureauMUMBAI: Gujarat under Narendra Modi may have developed a stature as the best place to do business in the country; but when it comes to insurance policy holder behaviour, it is among the bottom ones due to bad behaviour. As a result, insurers are now charging a higher premium in the state than other parts of the country , or not selling covers at all in the state.
Average claims from Gujarat are twice than other states or the national average. The claim ratio -claim paid by a company divided by total premium collected -is at about 130-140% for Gujarat, while it is 60-70% for the rest of the country, industry estimates show.
“Claim experience in Gujarat is the worst among all states in health insurance,“ said Nikhil Apte, chief product officer at Royal Sundaram General Insurance. “Insurance companies exercise prudent diligence in Gujarat to see that fraudulent claims are not paid because it will burden the genuine policyholders.“
This abnormal pattern of claims has resulted in insurers charging more for every policy they write in the state, compared with say Mumbai in Maharashtra, or Chennai in Tamil Nadu.
Insurance companies have pegged Gujarat premium as the highest in the country . For an indemnity cover of Rs 2 lakh, a 30-year old will have to pay `9,500 in Rajkot, and for the same cover it is Rs 8,000 in Nagpur. On an average, a Gujarat resident pays about 15% more for insurance cover.
Some of the companies have developed a stricter norms for payment of claims too.
“There are specific locations in Gujarat like Surat and Mehsana where percentage of claims are higher compared to the rest of the country," said T R Ramalingam, president, Bajaj Allianz General Insurance. “We have put every claim from there under investigation.“
There are three kinds of in surance products where frauds are prevalent in Gujarat -hospital cash, indemnity and personal accident. Hospital cash is a low-ticket size product, where agents collude with hospitals and generate various bills to dupe insurance companies.Insurers have blacklisted 50-60 hospitals in Gujarat.
One such fraud was exposed when a person in Surat had bought a hospital cash policy with Rs 2,000 from 10 insurance companies. The policy pays fixed benefit for each day of hospitalisation. He had claimed lakhs of rupees from various companies, before his fraud was established, said an insurer who did not want to be identified.
He could make easy money because of the flaws in the policy .This policy pays without the actual medical cost and takes care of the additional expenses.
“This was a learning experience for insurance companies and they started to investigate all claims from the state,“ said Apte. A policyholder made claims of `25,000 from four companies under indemnity plan for dengue and viral fever where the hospital colluded with the agent to generate bills.The fraud was later discovered and companies went on to blacklist several hospitals.
Average claims from Gujarat are twice than other states or the national average. The claim ratio -claim paid by a company divided by total premium collected -is at about 130-140% for Gujarat, while it is 60-70% for the rest of the country, industry estimates show.
“Claim experience in Gujarat is the worst among all states in health insurance,“ said Nikhil Apte, chief product officer at Royal Sundaram General Insurance. “Insurance companies exercise prudent diligence in Gujarat to see that fraudulent claims are not paid because it will burden the genuine policyholders.“
This abnormal pattern of claims has resulted in insurers charging more for every policy they write in the state, compared with say Mumbai in Maharashtra, or Chennai in Tamil Nadu.
Insurance companies have pegged Gujarat premium as the highest in the country . For an indemnity cover of Rs 2 lakh, a 30-year old will have to pay `9,500 in Rajkot, and for the same cover it is Rs 8,000 in Nagpur. On an average, a Gujarat resident pays about 15% more for insurance cover.
Some of the companies have developed a stricter norms for payment of claims too.
“There are specific locations in Gujarat like Surat and Mehsana where percentage of claims are higher compared to the rest of the country," said T R Ramalingam, president, Bajaj Allianz General Insurance. “We have put every claim from there under investigation.“
There are three kinds of in surance products where frauds are prevalent in Gujarat -hospital cash, indemnity and personal accident. Hospital cash is a low-ticket size product, where agents collude with hospitals and generate various bills to dupe insurance companies.Insurers have blacklisted 50-60 hospitals in Gujarat.
One such fraud was exposed when a person in Surat had bought a hospital cash policy with Rs 2,000 from 10 insurance companies. The policy pays fixed benefit for each day of hospitalisation. He had claimed lakhs of rupees from various companies, before his fraud was established, said an insurer who did not want to be identified.
He could make easy money because of the flaws in the policy .This policy pays without the actual medical cost and takes care of the additional expenses.
“This was a learning experience for insurance companies and they started to investigate all claims from the state,“ said Apte. A policyholder made claims of `25,000 from four companies under indemnity plan for dengue and viral fever where the hospital colluded with the agent to generate bills.The fraud was later discovered and companies went on to blacklist several hospitals.
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