​An insurance policy is a tool which helps you fight against the economic or financial losses. However, will you be eligible for any financial support or reimbursement from your insurance provider if there are issues/errors found in your policy? Probably not! But, in such a case, who is to be blamed for the unpaid loss?
 
How would you feel if in spite of fulfilling all the formalities towards your insurance policy, you stand the chance of not getting your claim?
 
For instance, health insurance is one such plan which lets even a common man access best possible medical treatment at most affordable price. Nevertheless, speaking out of my personal experience, today even when I am covered under a family health insurance plan, I stand at a risk of facing financial loss, if I ever have to claim.
 
Here’s why…
 
Following three claim free years on my family health insurance policy, this year at the time of my policy renewal, I was surprised to note that my health insurance policy’s renewal premium was revised with an upward loading of more than 50%. On enquiring with my insurance provider, I was informed that the loading on premium was due to restructuring of their premium structure. However despite all odds, I managed to pay the premium. But unfortunately, the saga did not end there.
 
A week after the inception of my policy, my insurance agent handed over the policy copy to me. On scrutinizing the policy, I found that the inception date of the policy which ¬¬should be 2010 has been wrongly put as 2012. I took it up with the agent who promised to get the change implemented in a couple of days. However, even after waiting for a month, the changes weren’t made. On following up with the agent, I was told that it was a system issue and has happened to all the customers. The agent later said that he was non committal about the endorsement (getting the changes done) and asked me to take it up directly with the insurer. He also advised me to write an e-mail to the Senior Div. Manager which I did with subsequent follow ups on e-mail and phone but without zero result.
 
During these follow-ups, they told me that this is a system flaw that cannot be rectified. They just gave a verbal assurance and said that there will be no problem in case of a claim. But, on my continuous insistence for an endorsement document, they provided me with a letter (on their letter head) with the corrected inception date. As mentioned earlier, this whole process took over a month’s time.
 
I wished things to be smoother thereafter, but issues with my family health insurance policy seem to be never-ending.  It’s over 1.5 months now, since I have renewed the policy, but I am yet to receive the health cards from the TPA. My insurance provider and the agent have asked me not to worry as it will take some time.
 
On a usual note, my mails to the insurer in this regard have not attracted any reply. On following up with the insurer, I was asked to take up the matter with the TPA. On the other hand, the TPA was clueless about the policy. I reported the matter to the insurer, but their response is still awaited.
 
This is an example of poor quality of service in all aspects.
Firstly the exorbitant increase in premium is an absolutely anti customer measure. Considering the product being of financial nature for individuals, it causes a lot of hardship for the insured.
Secondly, the problem with the endorsement being not received due to system issues is
totally unacceptable. The quality of insurance service is not determined solely by their claim service. We customers pay insurance premium to buy the promise of getting all services associated with the policy. But in this case that promise or the product is not being delivered to the customer satisfaction.
 
Thirdly company’s and TPA’s failure in providing the customer with the health card in time, falsifies the prospect of a hassle free settlement in case of a sudden claim.
Today, me and my family are covered under a family health insurance plan, but still we stand at risk of not getting any claim if ever required.
 
I could have saved my family and myself from this risk, if I would have looked for other insurance providers at the time of policy renewal.
 
It is often said that even while renewing your policy, you should look around and do a comparative study of different insurance policies available in market. At the same time, it is also advisable to find out about the quality of services offered by the insurance company.
 

I have learnt it hard way, and would advise all of you to be more aware about not only your insurance policy, but also about the insurance provider. Gather information from all possible sources like internet reviews, family & friends, etc. on the overall claims experience, responsiveness, etc. of the insurance provider. Also try to find out about the changes and number of changes the company has implemented in its product, since the time it was launched. Too many changes would indicate that there could be more in future.  
 
Article by Amitava Banik