Most insurance portals or apps are maintained by insurers or aggregators with a primary focus on selling insurance, apart from other aspects. But the litmus test of insurance is in claim satisfaction and meeting insurance needs. Resolution of any such unmet needs may not be as convenient as buying insurance in the first place. Enter Insurance Samadhan, a web portal/mobile app, that resolves insurance queries — for a fee. Insurance ombudsman and legal process should be the final resort for policyholders, but a convenient mobile app can save time and effort for policyholders.
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Web portal
The site lays out the process involved in resolving insurance queries. After uploading contact details and policy documents, the team reviews and confirms cases that meet their criteria. Then a one-time registration fee of ₹500 is charged to initiate proceedings. Once the claim is resolved successfully, the team charges 12 per cent of the resolved claim amount, called a success fee.
From mis-selling of insurance, rejected claims and lapsed policies, the team handles most queries. Mis-selling should be identified in the free look period (15-days) when policy can be cancelled. But even beyond the time frame, the team handles mis-selling for aggrieved policyholders. In case of claim rejection for non-disclosure of full information, pre-existing diseases or medical test issues, the team helps in refiling the claim after understanding the gaps that led to rejection.
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A health claim involves the administrative departments of hospital and insurers, and can lead to delays in processing. The Insurance Samadhan team can intervene for timely resolutions. Reviving a lapsed policy after a long gap is also taken. NRIs with a portfolio of insurance policies in India may find the services of the team useful in tracking, maintaining and drawing timely benefits from the policies, which otherwise may lapse.
The portal mentions a span of 15-30 days for clearing issues with policies. But the team can escalate the matters to insurance ombudsman or take the legal route as well, if the case merits such intervention. The time increases to 3–6 months for resolution in such cases.
Polifyx – mobile app
The above can be viewed as a firefighting process. In order to prevent lapses in the first place, Polifyx mobile app from Insurance Samadhan can be handy. Policyholders can upload their policy documents on the application. It then analyses the policy, premium payment frequency, the intended benefits and gaps, if any, in the pre-qualification process. This should make the probable claim process in health or life insurance that much more foolproof from claim rejection, policy lapses, mis-selling and policy rejection. The app can also be used as a guide to make a claim as well, reducing any scope for lapses.
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Our take
Insurance is a contractual product between a well-entrenched insurer and an individual. However well-meaning the insurer is, the individual may slip through the intended protection net. A convenient backstop in Insurance Samadhan can be useful to aggrieved policyholders before reaching out to the Insurance Ombudsman. A 12 per cent success fee might seem excessive, but if the potential losses are high and the counterclaim seems an uphill task,professional help should be preferable.