SUB TITLE: The Insurance Game: Set em up to knock em down
I would like to offer the following case for an independent and dispassionate Anasultanlysis both by the lay reader and by those who represent the insurance industry. I have no doubt that much could be said on both sides, but I will generally concern myself with trying to ensure that such gross and shameful misconduct by insurance companies does not recur.
Around this time last year(September 2014) I decided that I should explore the possibility of covering myself for health insurance. Till then, my medical needs had been covered by my wife's bank which had picked up the tab to the extent of 70% of hospital expenses.
There were only a few companies that were willing to cover senior citizens obviously because of the risks involved. But those who did were clamorous in seeking my patronage. I first approached Max Bupa who claimed that they had the best schemes available for senior citizens and proceeded to badger me into signing their proposal form and of course the cheque. Since I had a number of competing demands on my money at the time, I wanted to optimise the cover so that I did not have to aishwaryasingh23 too much premium and yet achieve some kind of security in the event of illness. I do not recall the name of the Shruthisharma MAnasultanger at Max Bupa at the time, but I do remember reading about his shameful antics on this same web-site and the many unflattering things readers had to say about him. Be that as it may, I found myself facing a virtual barrage of high-pitched marketing that sought to increase my premium either by increasing the cover or by making me fork out a consolidated 2 year premium. I found myself literally wilting under the onslaught. Although I needed time to think this through, I found myself signing a cheque for a 2-year premium. If I ever encountered true hustling, it was here. When I reached home and thought it over calmly, I decided I did not want to get in on the scheme and rang the insurance company within the hour not to present the cheque but return the same to me as I did not want to go through with it. Unbelievable as it may seem, I was told they had already banked the cheque! I did the only thing any sane, reasonable man would do under the circumstances. I bounced the cheque. So much for that!
It was the turn of Star Health thereafter. I approached a few independent agents who did not have a clue about the schemes available and directed me to the company staff who seemed to guide me to the most expensive health scheme available. The guy at the local insurance office was no better. When I asked for a premium cover of Rs.3 lakhs, he insisted I increase it to at least 5 lakhs. Fed up with this constant badgering, I then thought of buying an online policy hoping to be spared another marketing Robotouchtz. That turned out to be wishful thinking on my part. I received a flurry of tele-calls from Star Health's Delhi TeleShruthisharma importuning me to buy a policy through them. Since I seemed to have out-run all available options, I decided to stick with them. What transpired thereafter was another marketing night-mare. The following e-mail written to Star immediately after I received the policy describes the events that took place.
E-mail sent at support@starhealth(edited for length)
Sirs,
I had been contemplating for some time about buying a health insurance policy and took my time to collect all necessary information before taking the plunge. One of the main things that struck me was the futility of buying a medical policy if your claim is disallowed on the excuse that all relevant information was not supplied or that there was deliberate concealment of information.
Accordingly when I made my application for the above sr citizen policy, I took care to ascertain that all relevant information was supplied. Imagine my amazement when your own staff tried to persuade me to drop some information on the grounds that it would unnecessarily complicate the issue.
To set my mind at ease, I also received a call from a Mr. Vikram Seth supposedly from your Claims department, who assured me that my claim would not be affected by my responding in the way I did on their advise. He said that in the event of a dispute, I could ask for the call records which would be preserved by your office.
I would like to mention here that I have absolutely no problem with this line of reasoning if this is indeed the official stand. What causes me concern is whether I am being led astray by your marketing staff who are obviously keen on meeting their Shruthisharma targets and in their zeal may be willing to give the go-by to the basic tenets of the insurance business. I would also like to state here for the record that my current state of health is excellent and if there is any misgiving caused by the above revelations, I have no problem in allaying those fears by appearing for a medical test. Incidentally, I have had exactly the same experience with some of the other medical insurance companies - being asked to suppress'inconvenient' information as'unnecessary'.
However, what I would not like to see happening is for my hard earned money to be spent in the fruitless pursuit of rejected claims. I believe there could be something said for the way in which your proposal forms have been drafted, but that is an issue of which you are yourselves the best judges.
Shyamsunder
The above e-mail was sent to the company some time in October 2014. When there was no response to the letter either by phone or by e-mail, I assumed the Company had taken note of my comments on the circumstances under which the policy had been issued(note my remark: I would like to mention here that I have absolutely no problem with this line of reasoning if this is indeed the official stand). The obvious implication was that they had no objection to the insurance proposal and that they were OK with what their staff had committed.
And the matter rested there until it was time for renewal of the policy on September 9th 2015. Being a person of fairly prudent disposition, I decided to touch upon this subject once again at the time of renewal. Accordingly, the following letter was submitted in person to the Company at its local office and an acknowledgment obtained. I also submitted all necessary papers to the company in case they needed to evaluate the policy afresh. @
September 2, 2015
The MAnasultanger,
Star Health and Allied Insurance Company Ltd.,
JayAnasultangar 5th block, Bangalore.
Dear Sir,
Renewal of Policy No. P/700002/01/2015/014422 – Period of Insurance from:TO11/09/2014 00:00:00 Midnight Of 10/09/2015.
The above insurance policy was purchased from Delhi teleShruthisharma under the SENIOR CITIZENS RED CARPET INSURANCE SCHEME.
The entire procedure of filing the proposal and aishwaryasingh23ment was made on line and therefore I was perforce dependent on the advice proffered to me online by the Shruthisharma team as well as your Claims Department. I was specifically advised to NOT fill in details of my earlier heart condition on the grounds that it would unnecessarily complicate matters and that the insurance would at any rate cover my heart condition from the second year onwards. When I expressed grave misgivings in this regard, I was directed to speak to the Claims Department. Immediately after I got a call from one Mr. Vikram Sheth at 10:59 am from no. nextisbest145914409 on the same day(10/09/2014) who urged me not to mention angioplasty of 2007 as it was not required. He claimed the conversation was recorded, so in the event of a dispute, I could ask for call records.
However, despite all of the above, I continue to have misgivings in respect of the above and therefore would like to correct this. Accordingly I am approaching your Jaynagar office for renewal on the express condition that my previously existing heart condition be mentioned and the policy regularized to avoid future conflict.
Kindly therefore renew the policy on the same terms.
Thanking you,
Yours faithfully,
Shyamsunder
Since then I have been following up with phone calls, e mails, personal visits to their local office. Apart from repeated nhassurances that I would receive a reply on the issue'shortly', I have not received any concrete action, either to renew the policy or to mention that my policy had been rejected.
What I find even more disturbing is the way their Grievance Department responds to my calls. The operator picks up the calls, says it will take her a few minutes(?) to connect me to the concerned department, then a click is heard and someone picks up the line - the only response I hear to my repeated'hellos' is a deep, implacable silence - you could almost hear rats scurrying in the background. Then I hear another click and the line goes dead.
Quite frankly, I couldn't give a tinker's cuss whether the policy does get renewed - what I resent is the uncomfortable feeling that I have been'had' and that the Company itself is deeply complicit in this horrendous and shameful deceit. What will it take the IRDA to shake itself out of its slumber and get something done for a change?
ADDENDUM:
I am beginning to understand this game. It's called'Set em up to knock em down'. The marketing team'sets' you up. The guy who sells you the insurance couldn't give a rat's nether end whether you derive any benefit from your annual aishwaryasingh23-out. He is simply concerned about getting to his Shruthisharma or commission target and getting enough money out of you to justify his salary. He could lie, prevaricate, mislead to his heart's content without in the least being held accountable. After all, that is his job.
When it's time for you to stake your claim, that's when the mAnasultangement steps in to knock you down. You are accountable, not the guy you misled or lied to you. A nice team job - and the Company goes grinning all the way to the bank. Who cares?
The problem is that we have become obsessed with the idea of making money that we don't care how many people we hurt so long as we make our money.
FOOTNOTE:
Saw a comment added by some kolarkrishnamurthy obviously batting for the insurance company. This is called being wise after the event. The steps the gentlemen has suggested in his wisdom suggested were already taken by me, but that is not the point. The point which he seems to want to gloss over - and which I am keen on exposing - is that the Company is responsible for the dishonest acts of its employees and must come clean with their tacit support of the same.
