It is always a blame game when it comes to compensation of claims. It is not the customer who is at fault all the time; often, it is the lack of awareness that leads to grievances.

IN THE financial services area, consumer courts receive the largest number of complaints on medical insurance claims. Complaints are largely on account of underpayment or even rejection of claim payments by health insurers. Considering that events leading to health insurance claims themselves are stressful, any issue with the insurance compensation only adds to the stress.

Industry experts say there have been some common misses by customers while making a claim. Let’s look at what you need to do to ensure a hassle-free health claim.

Adequate paperwork
Insufficient documents are some of the most common causes of a dispute. As per Medi Assist India chief executive Madhavan B, a Bangalore-based third party administration company (TPA): Insurers ask for original bills and documents to ensure that customers do not make multiple claims. Also, you have to submit a document called discharge summary, which adds to the authenticity of your claim. He says the simple logic is that every outgo has to be supported along with an authentic document, which justifies the expenditure. For example, if you claim for consultation receipt by the doctor, then you have to submit the prescription along with the claim form. Similarly for diagnosis, you have to submit the diagnostic report and medical reports such as X-rays and scans for an operation. Similarly, the medical bills have to be numbered. Just a list of medicines on a clinic’s letterhead or with a rubber stamp will not suffice. In fact, the list of documents you have to submit is mentioned on the reverse of the claim form or any of the TPA’s website. Just a bit of reading and effort can save you from all the hassles and ensure timely compensation.

Get the timing right
You have to submit all relevant documents along with the claims form within 30 days from the date of discharge of the patient. As per industry estimates, 25-30% of customers do not maintain this time schedule. On paper, insurers do not entertain any claims after 30 days. However, in reality, the insurance companies do consider such delays on a case to-case basis. If the reason for delay is genuine, then the insurer may pay the compensation.

What you need to know?
You can take a medi-claim policy to financially aid you at ailing times. However, every policy comes with some provisions, exclusions and riders. You may have opted for a deluxe room along with a television at a hospital. But that comes with a premium and it’s not necessary that your insurance claim pays for additional luxuries you opt for.

So it’s important for you to know what your policy covers and what you have to pay yourself. Broadly speaking, health insurance policies cover boarding, nursing and diagnostic expenses like room rent charged or doctors’ fee A health policy, however, doesn’t cover ailments in the first year from the effective date of the policy. It covers hospitalisation charges for heart attacks, strokes, medicines, loss of limb or other parts of the body due to accident, injuries and maternity expenses. You cannot claim for expenses on hospitalisation, incurred in the first 30 days. Similarly, your health policy will not cover pre-existing diseases or health problem if you take insurance at a later stage. Pre-existing disease is the one you have at the time of taking policy and which you have not disclosed. For example, if you have an asthma problem or diabetes, then you can’t claim the expenses incurred on the treatment for these health problems under a medi-claim policy. Last, but not the least, a mediclaim cannot come to your rescue all the time. ICICI Lombard and Oriental Insurance give insurance cover up to the age of 75 years. Bajaj Allianz, on the other hand, gives you a medi-claim policy if you are less than 50 years while the age limit for senior citizens is 75 years. New India Insurance offers policy till 80 years.

Health-care costs are going up and at any point of time, you should be able to get the best doctors at affordable price. In fact, you start a mediclaim only to ensure that you provide for your medical expenses. So don’t get lax and be sure of what your policy reads well in advance. That will help you during contingencies!

As children one of the phrases taught to us was “Leading a Dog’s life” which meant having an extremely uncared for existence. Well now even a few fortunate pets don’t have to be afraid of such an eventuality. As SHREEN Mistry, a South Mumbai housewife, walks into an animal clinic, the vet’s bill is the last thing on her mind. Mistry isn’t another consumer who’s extravagant with her money — she cares less because her pug, Pluto, is insured.

Pluto, one of the four million pets across India, is covered under pet insurance, a growing fad among pet owners as well as the uber-rich who spend big money to acquire the best pedigree. Pluto and other lucky pets are also on the radar of several insurance companies who see a potential money-spinner here. Pet insurers say there are more than four million pets across 27 major cities in India and the total pet industry, including pet insurance, is estimated at around Rs 400 crore.

At Rs 50 crore a year, pet insurance is a very small segment of the insurance business, but those in the fray say business will take a leap once the awareness about the plans grows.

Oriental Insurance Co chief regional manager RN Ghelan says that we would not know the exact size of the market (for pet insurance). But it is growing as more and more pet owners are becoming aware of its existence and benefits.

Customised pet policies on offer
In addition to dogs, Oriental Insurance has also insured elephants and horses.
The policy is a niche product where pets are generally restricted to dogs. “The sum insured varies and the premium is anything between 3-5% of the sum insured,” says TA Ramalingam, head-underwriting, Bajaj Allianz General Insurance, which offers pet insurance.

The pet insurance plans available in India cover accidental death, death due to disease, sickness, disability and a public liability cover. The sum assured is based on the value of the dog, which has to be certified by the local Kennel Club or a veterinary doctor. “Presently, United India Insurance Co, New India Assurance Co, National Insurance Co and Oriental Insurance Co are the major market players in the pet insurance segment,” says Rahul Agrawal, CEO of Optima Insurance Brokers Pvt, a specialised insurance brokering company.

The insurance companies may also come up with client-based pet insurance. Iffco Tokio, for one, has a general pet insurance scheme under its ‘home and family protector’ policy. Generally, insurers do not offer cover against theft or if the pet is lost, but some of them do customise available policies to include this.

Recently, a Delhi-based businessman who did not want to be named has imported a Rs 29-lakh German Shepherd from Germany. According to sources close to the businessman, he is very keen on insuring the dog, but is cagey as he fears revealing the real sum may also alert the income tax department. The dog is a V-rated one — a type of rating which suggests its bloodline. The price of the dogs varies from Rs 10,000 to anything, depending on the bloodline and often the number of international shows the dog has won.

The infrastructure market in India is the hot topic in discussions everywhere – from board rooms to dining rooms. A cursory look at the real estate prices gives you an idea of how infrastructure & especially real estate has caught the fancy of most people. Companies like DLF, Ansals & others are buying up huge chunks of land in anticipation of a boom. But unbeknownst to all LIFE Insurance Corporation (LIC) is outbidding some of the leading private realty players to acquire huge tracts of land all over the country. The corporation plans to augment earnings by developing these properties into commercial office complexes and subsequently leasing them.

LIC, which manages over Rs 6 lakh crore of assets, has spent around Rs 100 crore a year until 2006-07. This fiscal, LIC is reported to have bought land worth Rs 400 crore. According to LIC managing director AK Dasgupta, LIC has already acquired tracts of land in Delhi, Jaipur, and Kolkata. We intend to acquire additional land in any prime location that will be put on auction by state establishments during the rest of the year. Although, they haven’t acquired any land in Mumbai, they are also on the lookout for expression of interest (EoI) from government bodies.

LIC has made an acquisition of a 5-acre plot of land on Kolkata’s Eastern Metropolitan Bypass for a mind-boggling Rs 276.2 crore. The land has presumably been bought for constructing an “investment building”, which is basically a structure that will help the insurance major earn very good returns over a period of time. Sources said that the land was purchased to set up an `investment building’ either an IT park or a commercial complex to be rented out. While a large number of the LIC’s old properties are non-performing assets generating rentals of less than Rs 10 per month, new properties are generating decent returns.

So far, LIC had restricted itself to acquiring land from government authorities only. It hasn’t yet ventured into purchasing from private parties. Currently, LIC owns nearly 1,571 properties in India and some overseas. Of these, some 374-odd LIC real estate portfolios are primarily investment properties. It also has some free-hold lands in metros, a majority of which will be used to house offices or employee families. The surplus may be used to boost the firm’s rental income.