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Empowering Women Professionals

In the contemporary professional landscape, the empowerment of women and recognition of their contributions is not just a matter of social justice—it’s a strategic imperative for organizations……..

Unlocking your potential

In the hustle and bustle of our daily routines, it’s easy to get caught up in the monotony of ourtasks and settle for the status quo. However, deep within each of us lies a reservoir……..

WORKPLACE CULTURE

Workplace culture is critically important for a variety of reasons. It encompasses the values, beliefs, behaviours, and social norms that shape the work environment in an organization. Harnessing……..

The Power of Employee Engagement: Unleashing the Potential Within

In today’s rapidly changing and competitive business landscape, employee engagement has emerged as a critical factor for organizations seeking sustained success. Gone are the days when a pay check…….

Importance of Upskilling at Workplace

Almost 40% of Indian workers, according to a Survey, will require retraining and upskilling within the next five years. Although employee training is valued by many businesses, its execution is……

Virtual CMOs in Insurance Industry: Then & now!

Circa 2000, Insurance was privatised in India. It was promised to be the sunrise industry. There were many Doctors with decades of experience in insurance industry and they were absorbed in private……

INCHES 2.0 and Trends in Insurance Industry test

Way back in 2018 a report published by WNS gave its perspective on what are the Top Trends in the insurance industry, though I am certain we all can make more additions its worth mentioning the……

Leadership and Employee Retention

“A brand is defined by the customer’s experience. The experience is delivered by the employees- Shep Hyken” So, for employees to deliver a great customer experience, need to be guided in a special……

Operational Excellence is not only about Functional Domain!!

Individually and Collectively, we need to work towards making “Excellence” as a Way of our life, in our organisation. And for this to happen, the most important requirement is that we sustain……

Data Science And Machine Learning In Insurance

Insurers operate in an increasingly data-rich and algorithm-oriented world, where growing computational power allows machines to collect, transform and analyse data with even more efficiency. …

Digital Underwriting – The right tool for the job

Automating the underwriting process holds great potential, but to realise that potential you need the right product or products. There are plenty of software suppliers and plenty of decision……

Is Offline Insurance Selling Making a Comeback?

Recently according to a news reported in the ‘The Economic Times’ “Health insurance online sale spurts up to 30%, offline sales fall due to coronavirus impact”, which is a proof of both online……

Becoming “Carbon Neutral“ In Insurance

Carbon Neutral in Insurance is a subject where volumes can be written since it is a Programme that is yet to emerge in the Industry. Insurance, as an industry is conservative with plenty……

Insurance Fraud

A news item in a leading newspaper on 29.2.22 must have shocked many readers. Knowing that the fraud really occurs is one thing; but knowing the magnitude is another thing! This Rs 100 crore a day……

Stress management in JFM! – Part 2

Is Underwriting as a stressful job? This question has been doing rounds for quite some time & we thought it’s the right time to take a deep dive into this subject. In Indian Context, the best way……

Stress Management in JFM! – Part 1

Stress is any demand (physical or mental) that is placed on our body. Stress is a state of anxiety produced when events and responsibilities threaten to exceed one’s coping abilities. Both Major……

Demystifying Medical Coding

COVID 19, a global pandemic, will go down in history as one of the deadliest disasters of the modern era. As of December 2021, 280 million people have been victims of this notorious virus, out of……

Another JFM!! So what else is new?

We have survived two years of the COVID 19 pandemic. In the last two years, we all have made drastic changes to our everyday lifestyles and how we go about doing things. As soon as we feel the……

Why External Medical Audit Is Mandatory for Health Insurers?

A survey conducted by Kroll and Internal Audit Foundation, concluded “80% of Internal Auditors face barriers while getting Involved in Fraud Risks Management”; this applies as much to health…….

How can an insurer question the doctor/line of management?

Insurance companies are facing challenges- high pending cases, high claim ratios and paying crores of rupees just because doctor(s) won’t answer the query raised or the insurer does… …

Changing your Insurance product structure? Time to be CAREFUL!!!

Policy structures seldom change but when it changes, it results in a pool of challenges for the insurers- satisfy the regulator on one hand as well as ensure self-protection via a medical, legal……

Repudiated Insurance Case at a Legal Forum

An insurer repudiates a claim only after scrutinizing proper policy documents and analyzing whether it is rational. But despite that some grievances against the insurer reach the legal forum whose……

Pending Cases: D-JFM Scourage

December in geographies following Jan-Dec financial year and JFM quarter in India are crucial for the insurance industry; being the closing of the financial year. Industry operates under twin……

Medical Management

50-60% of death claims and 100% of health claims need prudent review of the clinical data for a well-informed decision. Unfortunately Claims Management is discussed in the context of administrative ov…

Demystifying Chronic Kidney Disease

50-60% of death claims and 100% of health claims need prudent review of the clinical data for a well-informed decision. Unfortunately Claims Management is discussed in the context of administrative……

Profile of a Fraudster

One or more of the following three variables are usually evident in any proven instance of insurance fraud. In large percentage of such claims more than one exists as whatever be the main trigger……

Technology disruption in Insurance Risk Management

Insist of Rational & Customary Treatment (as already mentioned in policy documents) by ensuring your teams deploy Standard Treatment Guidelines into EACH claim adjudication (incl OPD claims)….

Insurance Fraud – A Global Malaise

50-60% of death claims and 100% of health claims need prudent review of the clinical data for a well-informed decision. Unfortunately Claims Management is discussed in the context of administrative ov…

Covid experience and Insurance Industry

COVID 19, a global pandemic, will go down in history as one of the deadliest disasters of the modern era. As of December 2021, 280 million people have been victims of this notorious virus, out of……

Cloud-based Medical Intelligence To Contain Health Insurance Fraud

Applying data analytic algorithms on conclusion(s) of both concurrent and post facto clinical audit conducted on life and health claims revealed that……

ECG Limb Lead Reversal: Incidence & Impact on Insurance Underwriting

Innocuous lead reversals during ECG (pre-issuance medicals) can be deceptive and cause difficulties for the insurer in decision making causing acceptance of high-risk……

Mental Health Cover in Insurance

An ever-ongoing debate (in the grapevine) is on in the Indian insurance industry on ‘whether to cover mental health in health insurance or not?’ Of course, Of course, similar debates……

Myth vs Fact #9

Most of Acute febrile illness patients, can be comfortably managed on domiciliary management. A spike of 1030F temperature is not a criteria for hospitalization. Only patient’s requiring vital organ…..

Myth vs Fact #8

Covid displaced usual chart-toppers heart attack and cancer to become the leading cause of death in the city in 2020. Out of 1.1 lakh total deaths recorded in the first year of the pandemic……

Myth vs Fact #7

Corona has been around for over 2 centuries and it is not going anywhere sooner! Like all viruses, Corona also is mutating – and continuously!! The SARS-CoV-2 virus has mutated over time, resulting……

Myth vs Fact #2

Insurers many a times faces challenges because they live with a myth that, “Insurer cannot question the doctor in case a clarification is needed for rational decision making and no avenue if they……

Myth vs Fact #6

The quest of, “Inclusion of mental illness in Health Insurance” has perturbed the insurance industry by raising concerns with regards to it’s potential of fraud and measurability. Defining factors……

Myth vs Fact #5

Despite the race of offering unique cover in health insurance, insurers are some how wary of offering cover for mental illness. The common fear/ concern is of abuse. It seems there is comfort in……

Myth vs Fact #4

With barely 5-7% cases being repudiated, the common perception is against the insurer……

Myth vs Fact #3

There are multiple levels of adjudication before an insurer decides to repudiate a case. Despite such diligence there is always a worry whether this would jeopardize their reputation and should it……

Myth vs Fact #1

Medical management claims, in reimbursement stage, are more prone for abuse as it is felt that all dengue patients need admission & antibiotics need to be administered. The catch question that comes …

Case Study #24

This is a case of 37 years old male who was admitted from 4/8/23 to 15/8/23 for pain and swelling at the anal region with bleeding per anum. He was diagnosed with ‘Prolapsed Internal Hemorrhoid………

Case Study#23

A 26-year-old Male, Graduate, working as a software professional with 12L annual income, applied for a term cover of 1crore, with Critical Illness Rider. He was eligible for financial and medical……..

Case Study#22

case of 28yrs male who presented with c/o high grade fever, shortness of breath, cough with expectoration and extreme weakness. He was admitted from 11/3/23 to 16/3/23 and was diagnosed……….

Case Study#21

32 years female was admitted for 2 days with c/o fever with chills, body ache, nausea +, decreased oral intake, yellow urine and burning while passing urine, for 3-4 days. On admission her vital…….

Case Study#20

Minimum Income Criteria is the criteria set by the re-insurer – at which minimum income a particular plan will be issued. This income criterion is different for different plans and for Salaried……..

Case Study#19

When the documents were being perused by our team of doctors, they noted that the procedure mentioned in the discharge summary was Reduction done under C Arm, ORIF (Open Reduction & Internal……..

Case Study #18

This is a case of 24 years male who was admitted for 8 days for high grade fever, cough, generalised weakness, vomiting, headache, since last night and breathing difficulty since last night……

Case Study #17

A 35-year-old Female, married, post graduate working for a reputed bank with 5 Lac Annual Income had requested for 50 Lac cover and was eligible for complete cover. LA had declared a BMI of 30.3………

Case Study #16

This is a case of death claim of a 34 years of male due alleged snake bite. We were asked to opine whether the insured died because of snake bite or some other poison. The death of the insured………..

Case Study #15

Male, Married, Graduate, Salaried Individual – NRI (United Kingdom) working in the Food and Beverages industry, specifically a Cake shop as an administrative service manager had provided all NRI……

Case Study #14

67 years old female patient presented with h/o prolapse uterus for 15 days. The gynaecologist examined her and advised for vaginal hysterectomy. The patient got admitted within 5 days of the first……

Case Study #13

LA (Life Assured) had Acute Necrotizing Pancreatitis (ANP) in 2012. Necrotomy of pancreas was done. LA was admitted in hospital for 3 months, doppler done in 2012 mentioned in documents. …

Case Study #12

28 years, old male was admitted in a hospital in Mumbai from 17/12/22 to 18/12/22 with c/o Fever; backache, heaviness in bilateral lower limb, difficulty in walking for 1 month Right lower limb……

Case Study #11

Life is full of pressure. Time and productivity pressure is part of an Underwriter’s daily routine. This results in minor omissions which could have greater impacts. Today, we discuss a case which……

Case Study #10

Hereby we will investigate a very strange situation we come across as an underwriter and with the vigilant eyes we caught the same. We were dealing with a 23yearold graduate who was a salaried……

Case Study #9

Misrepresentation in case of personal accident cases is very common. There have been instances where death due to natural causes are projected as unnatural deaths. There is a very fine line which……

Case Study #8

Pre Covid 19 pandemic the insurers were getting adept at managing abuse/ fraudulent claims in cases like acute febrile illness, gastroenteritis, dengue, and malaria. Using high ended antibiotics……

Case Study #7

“Utmost Good Faith “is one of the basic principles which makes Insurance different from other legal contracts. It requires life to be assured to disclose all material facts related to income……

Case Study #6

We get to see a lot of “High Value” & “High Networth” cases these days. The definition of High Value could be anything beyond sum assured of Rs 5 Crores and High Networth could be an applicant who……

Case Study #5

The reason why underwriting is exciting in its own way is because of the uniqueness of each proposal that an underwriter evaluates. They often say that learning for an underwriter never stops until……

Demystifying #11

Monsoon season is a time of joy and celebration for many in India. However, if down with one of the monsoon ailments, it could be harrowing………………

Demystifying #10

Obesity is a complex disease that occurs when a person’s weight is higher than what is considered healthy for his or her height. Obesity affects children as well as adults……..

Demystifying #9

I am certain anyone of us will be greatly offended, disturbed, angry, outraged, insulted and what not when our application for a life insurance policy is not accepted. Or, for that matter, when……..

Demystifying #8

Sepsis or Sepcemia is an ill-defined term referring to the presence of bacteria ortheir toxins in the blood. It is a life-threatening clinical conditon with extensive physiological (normal)………. …

Demystifying #7

Demystifying Kidney Failure Healthy kidneys are constantly filtering our blood, helping remove wastes and extra water, which are excreted as urine. Kidney (renal) failure implies that kidneys have…….

Demystifying #6

Demystifying Insurance Fraud It is a common notion that Insurance Fraud only affects Insurance companies and innocent policy holders. Well, NO!! Health Insurance Fraud affects the consumer the most……

Demystifying #5

Dengue is a viral disease transmitted by bite of a mosquito – in the day time (Malaria is transmitted by night time bite of another mosquito). Dengue presents with high fever and severe body ache……..

Demystifying #4

After the above philosophical quote, I saw in a temple, let me begin Demystifying. Death is the irreversible cessation of all biological functions that sustain an organism. For humans, death can also….

Demystifying #3

Demystifying journey from Coronary Artery Disease to Heart Attack Heart Attack or Myocardial Infarction (as it is called in medical parlance) – is the end stage of a disease entity coronary artery…….

Demystifying #2

Cancer is one of the principal causes of death in developed world & of morbidity in developing countries. It can affect people of all ages, but risk for the more common varieties viz. breast, stomach….

Demystifying #1

Chronic liver disease is marked by the gradual destruction of liver tissue over decades. Several liver diseases fall under this category, including cirrhosis of the liver and fibrosis of the liver. Be…

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