‘Don’t involve docs in insurance claims’

Mumbai: Doctors should not be involved in settling medical insurance claims, the Insurance Regulatory and Development Authority (IRDA) told the Bombay High Court on Thursday. Not only is there a shortage of doctors, but it could increase the cost of insurance business, it added. 

    A division bench of Chief Justice Mohit Shah and Justice Anoop Mohta was hearing a public interest litigation by activist Gaurang Damani on medicalinsurance woes. The PIL, filed last year, highlighted the plight of nearly 7 crore consumers paying Rs 11,000 crore annually as medical insurance after third party administrators (TPAs) stopped offering cashless mediclaim benefits. It also focused on the absence of regulations to govern the medicalinsurance industry. 
    IRDA had published draft regulations in June 2012. Its advocate Paritosh Jaiswal submitted that it was opposed to the petitioner's suggestion to involve doctors rather than administrative staff in the settlement of claims as it was not feasible. He said there was a shortage of doctors. Damani argued that the loss assessor or surveyor should be qualified under the Insurance Act. Jaiswal said TPAs are supposed to process and not settle claims. Damani countered that TPAs are given incentives to reduce claims, violating the Insurance Act. The judges summoned a senior officer of IRDA who will take a decision to its next hearing on January 7, 2013.