IRDA Notification No: IRDA/HLT/MISC/ORD/090/04/2015 (27-Apr-15) In the matter of M/s National Insurance Company Limited



This is based on two different replies to Notices to Show Cause, one vide letter Ref. No. ICL/HO/HIM/IRDA/2014-15 dated 31-07-2014, submitted in response to Authority Notice to Show Cause dated 24-07-2014 and other vide letter Ref. No. NICL/HO/HIM/IRDA/2014-15 dated 08-09-2014 which was submitted in response to Authority Notice to Show Cause dated 01-09-2014.

Two different Notices to Show Cause, (SCN) on observed deficiencies in the functioning of M/s. National Insurance Co. Ltd. (the insurer / NIC) were issued and in deference to the insurer''s request to hear them on the charges for which they had also filed written submissions, the undersigned during the course of the personal hearing held on 05.01.2015 at 1130 hrs. at the office of the Insurance Regulatory and Development Authority of India, Hyderabad heard the submissions of the insurer represented by Mr. P K Mahapatra General Manager, and Mr. N Banchur -- Deputy General Manager. On behalf of the Authority, Mr. M. Ramaprasad, Member (Non life), Smt. Yegnapriya Bharath, JD (Health), Mr. N M Behera, Deputy Director (Health), Smt. Jamuna Choudhury AD (Health Products-1) and Mr. K. Rajasimha, OSD (Health Products-2) were present in the personal hearing.

The submissions made by the Insurer in their written replies to the points mentioned in the SCN and also those made during the course of the personal hearing were taken into account.

The findings on the explanations offered by the General Insurer to the issues raised in the Show Cause Notice and the decisions thereon are as follows.

Charges as per Authority Notice to Show Cause during personal hearing:

1. Charge No. 1

The Insurer had issued "BOI National Swasthya Bima Policy" bearing No.261601/48/13/8500011437 to the Insured Mr. Santaram Walawalkar.

Mr. Santaram Walawalkar lodged complaints with the Authority and also sent RTI Applications alleging non-- compliance of the product with the Health Insurance Regulations 2013. The matter was also taken up with the insurer raising issues with respect to, Contribution Provision, Renewability provision, Grace Period, Free Look Period, Claims falling under two policy period, Cumulative bonus etc.

The Insurer stated in their email dated 12.09.2013 addressed to Mr. Santaram Walawalkar, that "The revised Policy has been filed with the Authority and will be available for issuance after getting approval for the same. Unless we have the approval of IRDA, the policies cannot be issued with revised wordings."

Thus the Insurer has given incorrect...

To continue reading