Four out of nine policyholders dissatisfied with claim settlement procedures: Consumer Voice survey

Every four out of nine policyholders have faced problems with their health insurance providers and third party administrators (TPA) at the time of getting their claims approved, a study conducted by consumer rights organisation Consumer Voice has found.

Out of this, most complaints were related to delay in authorising claims. ""Unnecessary delay by TPA in giving authorisation' is the most frequently occurring problem, as 28.1% of the complaints were related to this issue,"" the Consumer Voice said in its report. Documentation was another bone of contention, with nearly 26% of claimants polled citing 'unnecessary documents required by TPA/insurance company' as a key issue. Another source of dissatisfaction with service providers was the amount of claim settled. Close to 17% of the complainants who participated in the survey rated unjustified deduction by TPA in claim settlement as a major problem they have to deal with at the time of claim processing.

As per the study, around 55% of the respondents named Tata-AIG General as the insurer with whom they 'had a problem'. The private sector insurer was followed by standalone health insurers Max Bupa (51.2%) and Apollo Munich (50%), and general insurer Royal Sundaram (49.2%) on the list.

The survey was conducted across eight cities - Delhi, Mumbai, Kolkata, Chennai, Bangalore, Hyderabad, Ahmedabad and Lucknow - in order to identify health insurance providers who are 'actually making the right claims and keeping promises,' Consumer Voice said. The study posed questions to 3,312 respondents who had health insurance policies from various insurance companies.