case study on insurance company in india

Case study: How AI helped an insurance major improve its front-line employee retention

A leading life insurance company implemented a strategic people initiative to hire and retain the best talent while leveraging AI technology.

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Anurag Malik

EY India People Advisory Services Partner

Neha Sharma

The better the question

Is sales force attrition a necessary cost of growth?

With a finite talent pool to tap into, an insurance company was seeking a technology-based solution to help it hire and retain the best talent while keeping costs low.

O ne of India's leading life insurance companies, a joint venture between two global conglomerates, registered phenomenal year-on-year financial growth in the past few years. It aimed to be one of the top five life insurers in India in the next 3-5 years. However, controlling the attrition rate of the sales force posed to be a major hindrance and was impacting its bottom-line.

The company operates in an industry which traditionally observed high attrition rates along with a finite talent pool. Reducing the attrition rate and driving sales productivity became a strategic priority for the company. The company was also aware of the need to build a digital-led modern organization with minimal disruption of existing business and people processes. Hence, the company wanted to drive a strategic people initiative to control attrition, hire and retain the best sales talent available in the market on the back of an efficient data-backed process, and thereby, improve the bottom-line of the company.

The better the answer

An AI-focused solution helps diagnose core HR issues and make better decisions.

With the help of AI, the company was able to obtain a better view of its HR processes and make data-driven decisions.

EY conducted a detailed diagnostic of the organization structure and developed imperatives to understand HR processes better. Key focus areas for the organization were:

• Finalize current baseline attrition metrics and project success measures to review overall performance improvement directly resulting due to EY intervention
• Have a scalable  AI  based algorithm to determine quality of every new hire and incorporate renewed technical assessments of candidates
• Establish control levers to reduce dropouts across the hiring funnel
• Establish an integrated and centralized HR function to build an accountability-based ecosystem to ensure improved retention of sales force and higher sales productivity measures
• Develop robust data architecture to institutionalize factual decision making

EY worked on a 10-month-long  HR transformation  journey, while leveraging  EY TalentMiner (an AI based digital hiring solution) , which changed the way the client was functioning across its entire value chain.

The key initiatives of this digital transformation included:

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Ey talentminer - artificial intelligence (ai) based digital hiring solution.

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AI-based customized hiring algorithm development

An AI-based customized hiring algorithm was developed for each hiring outlet of the client. The degree of customization was basis the client’s existing data maturity and nature of the problem, i.e. specific to each role, channel and location.

HR technology enablement

The integration of the algorithm to the technology platform enabled mass screening and selection of candidates. This led to significant improvement in the quality and speed of hiring.

HR process transformation

Streamlining the entire employee life cycle and increasing the employees’ awareness of on-ground experience.

Data-driven decision making

Significant improvement in the data maturity index of the organization with single source database of every new joiner, which enabled easy access to any employee related information. This aided reporting and intelligence provided to the senior management anchored by the HR workstream.

Sustenance of program objectives

Month-long transition process included role-based plans across HR-business-strategy stakeholders, detailed knowledge transfer dockets and one-to-one training workshops. Cadence around periodic audits post exit were also implemented.

Adaptability to unprecedented situations

During implementation, the breakout of the  COVID-19 pandemic  was observed. The EY team extended the program duration and adjusted the key levers of the initiative to assimilate the impact of the outbreak on the changing business environment.

The better the world works

The manufacturer increased market coverage, built customer loyalty and boosted sales.

The company witnessed better performance across all aspects of their envisioned growth targets.

Over a period of just 10 months, the client started to reap the benefits of the integrated business and HR transformation initiative. The benefits came in the form of significant reduction in attrition related costs, enabling the client to improve its growth trajectory. This included:

Some of the more qualitative benefits delivered included efficient, scalable and robust HR processes, which were enabled and automated by an integrated  technology  backbone. Another key benefit included adoption of a data driven culture within the organization.

The overall HR transformation process helped the client create a more resilient and efficient recruitment ecosystem backed by modern technologies such as AI, which are not only future-ready, but also equipped to better manage market volatility.

Arijit Chakraborty and Gautam Kumar also contributed to the case study.

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LIC Case Study | Success Story of Life Insurance Corporation of India

Ria Puneyani

Sales of life insurance policies are a vital source of revenue for any life insurance company and their primary motivation for doing business. Because today's business operations are so intertwined, claim settlement services significantly influence life insurance policy sales. People can use life insurance plans to cover a variety of hazards throughout life.

The insurance industry grew rapidly in the first two decades of the twentieth century. In 1938, it increased from 44 firms with a total business-in-force of Rs.22 crore to 176 companies with a total business-in-force of Rs.298 crore. The call for the life insurance sector to be nationalised had been voiced before, but it gained traction in 1944 when a measure to modify the Life Insurance Act 1938 was filed in the Legislative Assembly. However, it was not until 1956 that life insurance was nationalised in India when the Life Insurance Corporation was passed by the Indian Parliament on June 19.

Origin of LIC LIC's Objectives Growth of LIC LIC's at Present LIC's Products and Services LIC Services for its Employees LIC's Marketing Strategy Conclusion FAQs

Origin of LIC

The Life Insurance Corporation of India was established on September 1, 1956, by the Ministry of Finance of the Government of India, with the goal of making life insurance more widely available, particularly in rural areas, with the goal of reaching all insurable persons in the country and providing adequate financial cover at a reasonable cost.

LIC's Objectives

The primary goal of LIC is to promote life insurance across the country, particularly in rural regions and among the socially and economically disadvantaged, to reach all insurable individuals and provide them with appropriate financial protection against death at a fair cost.

Maximise people's savings mobilisation by making insurance-linked savings sufficiently appealing. Another goal is to function as trustees for the insured public in their individual and collective capacities, meeting the community's diverse life insurance demands as the social and economic environment changes.

LIC intends to involve all employees to the best of their abilities to advance the insured public's interests by delivering prompt and courteous service.

Growth of LIC

In 1956, LIC had 5 zone offices, 33 divisional offices, and 212 branch offices in addition to its corporate office. Because life insurance contracts are long-term contracts that require a range of services during the policy's life, LIC felt the necessity to extend operations and open a branch office at each district headquarters in subsequent years.

The LIC was reorganised, and it created a considerable number of new branch offices. It shifted servicing tasks to branches due to the reorganisation, and departments were declared accounting units. It had a significant impact on the company's success. You can observe that from about INR 200 crores in new business in 1957, the company only exceeded INR 1000 crores in 1969-70, and it took another ten years for LIC to reach the INR 2000 crore barrier. However, after reorganisation in the early 1980s, LIC had already surpassed INR 7000 crores in Sum Assured on new policies by 1985-86.

LIC's at Present

LIC has practically monopolised the solicitation and sale of life insurance plans in India, having existed as a massive insurance business for almost 60 years. LIC has expanded its operations outside of India to 14 countries to meet the insurance needs of Non-Resident Indians.

With an asset value of INR 2,529,390 crores, LIC is now India's largest life insurance business, controlled by the government. LIC's headquarters are in Mumbai .

It currently operates eight zonal offices and 113 divisional offices around the nation. It has 2,048 branches across India in various towns and cities.

In addition, LIC maintains a network of over 15 million agents that sell life insurance to the general population. The LIC had a total life fund of $28.3 trillion as of 2019. In the 2018–19 fiscal year, the total value of sold insurance was $21.4 million. In 2018–19, LIC resolved 26 million claims. With 290 million policyholders, it is the largest insurance company in the world.

The Life Insurance Corporation of India (LIC of India) is one of India's largest financial organisations, providing comprehensive financial solutions for all aspects of life. It has a customer base of around 23 crores, making it the largest insurance company globally. After Indian Railways, it is the second-largest real estate owner in the country. The LIC advertises through newspapers , radio, television, billboards, and other media.

LIC's Products and Services

The Life Insurance Corporation of India (LIC) offers a variety of life insurance plans. As a government-owned Life Insurance Firm, LIC's policies are in high demand and appeal to a broad spectrum of consumers.

LIC For endowment, LIC offers the Jeevan Pragati, LIC Jeevan Labh, LIC Single Premium Endowment Plan, LIC's New Endowment Plan, New Jeevan Anand, LIC's Jeevan Rakshak, LIC's Limited Premium Endowment Plan, LIC's Jeevan Lakshya, LIC's Aadhaar Shila, and LIC's Aadhar Stambh.

LIC Jeevan Umang specialises in life insurance.

LIC's Bima Shree, LIC's Jeevan Shiromani, LIC's New Money Back Plan- 20 years, LIC's New Money Back Plan-25 years, LIC New Bima Bachat, LIC's Jeevan Tarun are some of the money-back plans available. Money-back plans include LIC's Anmol Jeevan II and LIC's e-term Plan.

Their pension schemes include the Pradhan Mantri Vaya Vandana Yojana, LIC New Jeevan Nidhi, and LIC's Jeevan Akshay.

LIC Services for its Employees

Agents are being offered home loans.

The LIC of India's Agents Housing Scheme provides house loans to the company's agents. It has a separate subsidiary, LIC-HFL, from which many housing plans are moved for fairer distribution.

Employees are given meal coupons.

In September 2010, the Life Insurance Corporation of India (LIC of India) introduced a one-of-a-kind benefit for all workers. The number of meal vouchers is determined by each team member's position in the hierarchy.

Team member participation in sports is encouraged.

Employees of the LIC of India are encouraged to participate in various sporting activities to improve their physical fitness and overall personality. Employees have also spoken on behalf of the company at different national and international levels. It has recruited numerous workers from its Sports Recruitment Quota to maintain competitive excellence in sports and to compete on an equal footing with other businesses.

Training its employees

LIC has begun to provide training to its staff at all levels of the organisation. It has established a distinct Human Resources Development / Organizational Development (HRD/OD) Department to develop and enhance capabilities, commitment and foster a learning and performance-focused culture.

LIC's Marketing Strategy

LIC Life Insurance's marketing approach is pretty basic. Its primary goal is to educate consumers about the company's different policies and brands. Personal selling, exhibits, demonstrations at events, advertising, and innovative schemes have all been used by LIC to achieve this goal.

As presents and incentives, policyholders are given bags, diaries, and calendars. As promotional activities, advertisements are displayed on TVs, newspapers, and billboards .

A mobile advertising van circulates across rural regions, raising awareness of the firm. LIC-Life Insurance has a website and a webpage where it provides thorough information on each potential inquiry to satisfy customers.

LIC is continually working to strengthen "Brand LIC" and strengthen the brand's link with growing market segments. It has done so by maintaining a regular media presence in national and regional outlets.

It has also sponsored several national and international programmes and a variety of activities such as newspaper campaigns and continuous coverage of goods in several publications.

Who is the founder of LIC?

LIC has been founded by Government of India in 1956.

What are the Subsidiary companies of LIC?

LIC subsidiary companies are:

• LIC Pension Fund Limited
• LIC Cards Service Limited
• IDBI Bank Limited

What is the number of employees in LIC?

There are 1,14,000 employees (2020) working for LIC, and over 10 Lakh LIC agents.

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Out-patient coverage: Private sector insurance in India

Ramandeep s. gambhir.

1 Department of Public Health Dentistry, BRS Dental College and Hospital, Panchkula, Haryana, India

Ravneet Malhi

Saru khosla.

2 Department of Periodontology, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India

3 Department of Prosthodontics, BRS Dental College and Hospital, Panchkula, Haryana, India

Arvind Bhardwaj

4 Department of Periodontics, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India

Mandeep Kumar

5 Department of Prosthodontics, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India

Background:

There has been a growth of 25% in the health insurance business in India during the last few years with the expansion of the private health insurance sector. The share of the private health insurance companies has increased considerably, despite the fact that from the patients’ point of view, health insurance is not a good deal.

To provide information and assess the current status of private sector insurance with regard to out-patient coverage in India.

Materials and Methods:

The present review was conducted after doing extensive literature search of peer review journals in Pubmed and various search engines like Google. Data of Indian private health insurance companies was also utilized. No limitation in terms of publication date and language was considered. The main focus of the present review would be on the private health insurance sector with a spotlight on the out-patient coverage and various obstacles faced by the private health insurance sector.

Out-patient (OPD) coverage is one of the important emerging trends in the private sector health insurance. OPD cover assists the insured to claim expenses other than that incurred during hospitalization. However, it is still not a full-fledged offering under health insurance and major insurance companies are providing this cover for an additional premium.

Conclusion:

Private is strongly being advocated and receiving growing consideration by our country's policy makers that can deal with alarming health care challenges in India. However, it is not the only option.

Introduction

Health care has always been a problem area for a country like India with a large population, majority of the people residing in urban slums and rural areas, below the poverty line. The Indian health care sector has received lowest percentage of the country's national budget and as a result health care expenditures are largely out of pocket (OOP). However, in recent years, Indian health care planners have advocated for the expansion of health insurance schemes in order to improve the health care reforms and reduce poverty.[ 1 ] This goal can only be achieved by implementing universal health insurance, which can be a major step in reducing health disparities and OOP health expenditure. Presently, numerous public, private, and community-based insurance schemes have come to coexist and even merge with each other, a situation that is hardly surprising in a country as diverse as India.[ 2 ]

There are various forces which have brought health insurance to the attention of Indian policy makers. These include – high ill health burden, low public spending on health care, high expenditure with regard to private health care and partial coverage of the already existing health insurance schemes. In the recent years, there has been a substantial private spending on health especially in terms of OOP expenditures on medicines. This is probably due to low national public health spending in India.[ 3 ] As a result of this, the private sector has been blooming, providing 80% of outpatient and 60% of inpatient care.[ 4 ] Research has revealed that it is not the hospitalization cost but the drug expenditure, which accounts for 60%–80% of the total OOP spending.[ 5 ] These findings suggest that insurance schemes which cover only hospital expenses (national insurance schemes in India) will fail to adequately protect the poor against impoverishment due to spending on health. In view of all the above findings, this paper intends to explore private health insurance in India with a spot light on outpatient coverage under this insurance.

Literature Search

An extensive review of literature search was done (electronic and manual) which engaged most of the articles published in peer-reviewed journals and other search engines like Google were also used for extracting relevant information regarding private health insurance in India. The review itself began with the search of relevant key words like insurance, private sector, India, out-patient coverage, companies, benefits, etc., in various search engines including Pubmed, MEDLINE, etc. Information regarding OPD coverage by private insurers was very limited in Pubmed. Web sites selling health insurance of different companies in India were also consulted like policy bazzar.com and bankbazaar.com. Reports published only in English language were included in the review. The spot light of the present review would not only be on the out-patient coverage provided by private health insurance in India but also on various factors that hinder the growth of health insurance in private sector. We also compared the features or benefits regarding OPD coverage provided by major health insurance companies in India.

Understanding and awareness of public regarding insurance

Recent reports suggest that public awareness and understanding of health insurance in India is poor. However, general public awareness of health insurance in Kerala and in some other parts in India is increasing as a result of the efforts of private health insurance agents.[ 6 ] Lack of necessary education and “culture” are perceived as “barriers” due to which people have difficulties in managing money and health and difficulty in learning this new technology. Poor and less educated people residing in both the rural and urban areas, consult private practitioners more than government practitioners and spend about twice as much on treatment from them than from government practitioners.[ 7 , 8 ] This thing has led to the deepening of poverty in both rural and urban areas, pushing the millions of people into poverty each year.[ 9 ] According to recent surveys and field works carried out in India, understanding of the entitled benefits and privileges remains confusing not only to the poor and illiterate people but also to the educated middle class citizens.[ 10 ] This could be due to promotional languages of the insurance sellers that is difficult to understand for the general public belonging to different educational backgrounds.[ 11 ]

Private health insurance (PHI) in India

PHI in India began with the establishment of General Insurance Corporation (GIC).[ 12 ] Private health insurers recognize India as a potential market due to its increasing purchasing power, growing demand for healthcare, an expanding competitive private healthcare market, and rising rates of chronic disease.[ 13 ] Eyeing this lucrative business opportunity, number of foreign insurance firms have invested in India during the last few years. However, in a country like India, providing insurance is a risky business venture due to a low level of insurance awareness as well as poor healthcare infrastructure in rural areas.[ 14 , 15 ] Mainly the middle-class population is targeted by private health insurers due to this profit-oriented approach. The cost of insurance policies for middle class families range from Rs 4000 per member and covering only in-patient treatment for a maximum of Rs 400000. There is greater health disparity and rising health costs for the poor as a result of this limited coverage (in-patient) and targeting particularly this income group, which serves to undermine national health equity goals.[ 16 ] There is abundant theoretical basis and empirical evidence from other parts of the globe that private insurance drives up healthcare expenditure. Moreover, in Indian context, where PHI mainly contracts with urban-based corporate hospitals, it is likely to increase cost.[ 17 ] Critics call for regulation of benefit packages, restrictions on risk-selection procedures, and greater protection of customers.

Out-patient department (OPD) coverage in health insurance

Outpatient insurance coverage includes benefits ranging from medical practitioner and specialist fees, routine check-ups, and vaccinations. Out-patient coverage may also include policy benefits for prescription medications, alternative treatments, diagnostic tests such as X-rays, and home nursing.[ 2 ] This type of insurance is generally not well suited to routine ambulatory care because its requirements tend to reasonably predictable and are of relatively low cost and people might be expected to meet these costs out of the pockets. Most people, however, do prefer it to be included at least those services (diagnostic and clinical) having bearing on their pockets.[ 18 ] However, there are number of benefits of having health insurance with OPD coverage:

• OPD cover assists the insured to claim expenses other than that incurred during hospitalization days
• Insured are entitled to more tax benefits as compared to regular insurance plans as they can get tax exemption on the premium paid for such health insurance policies
• Claim reimbursement on expenses can be done multiple times by the insured during the policy period making the monetary value of a health insurance policy with OPD cover higher than that of a regular health insurance policy
• This type of policy also covers pharmacy bills of the insured and thereby prove beneficial for those who have more expenses from the same
• Under OPD cover, the sum assured is based on the age of the insured; not on the basis of 24-hour hospitalization as in case of regular insurance.

Top companies offering OPD cover

There are many companies which are offering OPD coverage with general health insurance in India. However, some of the top companies offering OPD cover are listed in [ Table 1 ]. The premiums charged by these companies may vary depending upon factors like age, location, and prevailing taxes/GST.[ 19 ]

Top insurance companies offering OPD coverage in India[ 19 ]

Pricing hurdles in out-patient insurance

According to recent reports, some insurers have bought out-patient (OP) cover under cashless scheme for those hospitals that are linked with that particular insurance company. However, many believe that it would take a while before OPD cover becomes common as a product category in private health insurance.[ 20 ] Some companies extend OP cover under cashless scheme by payment of some additional premiums. Claim management would not be an easy task if OP becomes a full-fledged offering under health insurance. This is because there are frequent visits to a physician (in case of lifestyle disease) in case of OP cover whereas hospitalization is not a frequent event and leads to one-time claim settlement. Some other issues like absence of a national brand in the OP space be it dental, eye or even diagnostic, controlling frauds in matters pertaining in billing and uniformity in service for claims assessment and payment are hurdles in regularizing the OP cover.

Factors that frustrate the growth of private sector health insurance

There are certain factors that have curtailed the growth of private health insurance in the past and are likely to have an influence in the near future.[ 21 ]

• Lack of awareness in promoting health insurance to the general public at large
• Non-availability of reliable data and epidemiological information on the disease pattern and treatment cost that is requited for designing health insurance product specifications
• Risk of adverse selection of people with pre-existing ailments and unhealthy persons opt for the coverage
• Morale and morale hazard have had a negative implication on the insurance business
• Lack of actuarial data for the development of new product
• Lack of technically skilled manpower that has sound knowledge in the research and development activities associated with medical aspects of the health insurance and well-trained staff to meet the expectations of the clients
• Lack of cooperation and coordination with health care providers regarding processing and settlement of claims
• Lack of neutral bodies to carry out “Accreditation and Categorization” of health care providers.

Insurance with OPD coverage vs. Health cards

Discount cards or health cards are exclusive schemes that provide discounted rates on medical, health, and drug expenses by charging monthly or an annual membership fee but are in no way replacement for hospitalization cover. Almost all healthcare expenses are covered under health cards, including cosmetic treatments.[ 22 ] It is also of huge help to individuals who are at high risk, such as those with pre-existing ailments, and those who are refused health insurance, especially senior citizens, who face refusals or have to pay significant amount as premiums for a policy surrounded with lot many clauses and exclusions.[ 23 ] While a loyalty program from a hospital chain, will limit your options to the concerned group's facility, a health card from an independent company having a tie-up with multiple hospitals, individual medical practitioners, pharmacy chains, pathology labs, and diagnostic centers gives more flexibility of choice.

A typical health insurance policy does not provide offerings, such as discounts on dental treatments, pathology, and radiology expenses. In case of a health card plan, there are no caps or sub-limits. Depending on the plan and number of members registered, the membership fee of these cards ranges between Rs 1,000 to Rs 8,000. A basic plan provides a discount of 15–30% on consultations and 10–20% discounts on OPD treatments and various hospital procedures. In case of dental care, you are provided with free check-ups and up to a 50% discount on the total treatment cost. However, one should be very careful while opting for any health card as they don’t fall under any regulation unlike health insurance.[ 23 ]

Strengths and weaknesses of the paper

This review involved the search of multiple electronic databases, with no restrictions on year of publication. The reference lists of literature reviews were searched for further information that could also be included. However, it was not possible to search technical reports, papers from research groups or committees and pre-prints and it is possible that some relevant data may have been left behind. This could have accounted for some publication bias. Moreover, there was under reporting of some relevant information regarding the out-patient coverage on internet websites dealing with private sector insurance. There was also very limited information (lesser number of articles) available regarding outpatient coverage in databases like Pubmed, etc. This could be due to the fewer studies conducted and published on the current topic in the past.

Importance of the paper in Primary care/Family medicine/General practice

The present paper highlights and provides significant information regarding outpatient coverage in private insurance sector and also compares the existing schemes in different insurance companies. It is reported in some studies that nuclear families and families with fewer members are more likely to buy insurance policies and socio-economic factors including literacy, religion, occupation, and gender are important.[ 24 ] This aspect can contribute significantly towards family medicine. The topics discussed in the paper indicate where most misunderstandings and tension occur while buying and making claim under private sector insurance. People sometimes land into far more debt when they avail more expensive care than they can afford without realizing their insurance coverage at a hospital is limited. This paper brings out important aspects that should be kept in mind while buying and making claims under private health insurance so that the general public are not misled by the insurance providers. Some family clinics limit the amount of insurance coverage a person could draw upon during any one hospitalization as a matter of policy, possibly to educate patients that coverage was not in fact free but against a balance. Families often slip into debt regardless of insurance coverage for medical procedures as a result of the costs of essential follow up care. A better grasp of the enumerated areas could potentially lead to improvements in providing, explaining, and implementing health coverage, especially for those with limited resources.

India, a country with relatively developed economy and a considerable middle class population, offers most suitable environment for the development of private health insurance. At present, only a marginal role is played by private health insurance in health care system but it is gradually gaining importance. Private health insurance is certainly not the only alternative or the ultimate solution that can deal with alarming health care challenges in India. However, it is an option that is strongly being advocated and receiving growing consideration by our country's policy makers. Thus, the question is not if this tool will be used in the future but whether it will be applied to the best of its potential to address the growing and impending needs of the health care system of the country. The main challenge is to see that poor and the weak are benefitted in terms of better coverage (both inpatient and out-patient) and health services at lower costs without negative aspects of cost increase and overuse of procedures and technology in provision of health care.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

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Kotak General Insurance Case Study

Kotak General Insurance sets new standards for customer engagement & loyalty with Talisma digital platform.

Company Profile

Kotak General Insurance – A 100% subsidiary of India’s fastest growing bank, Kotak Mahindra Bank Ltd. Kotak Mahindra General Insurance was established to service the growing non-life insurance segment in India. The Kotak Mahindra Group is one of the leading financial services conglomerates in India and received its banking license from the Reserve Bank of India (RBI) in February 2003.

The company aims to cater to a wide range of customer segment & geographies, offering an array of non-life insurance products like Motor, Health, etc.

As a practice, the company seeks to provide a differentiated value proposition through customized products & services leveraging state of the art technology & digital infrastructure.

Business Challenges and Priorities

Being the 29th entrant in the General Insurance Industry, Kotak General Insurance, always believed that quality of services offered to their customers could help them create their rightful position in the industry. So even before they formally began operations, a hunt for a befitting CRM was initiated to ensure that KGI had a robust backend supporting their vision.

“At the management level, Talisma was the closest to meeting KGI’s business requirements, implementation targets & budgets”

– Sanjay Shingala AVP-IT

Kotak General Insurance

Priorities Identified Were:

• To integrate all customer care touch-points: Communication channels and service locations on a single and centralized enterprise platform for a 360-degree view of
• This included operationalizing a more effective and measurable customer experience framework across queries, services and complaints received at the Contact Centre, Online Portals, Emails, Snail Mails, Chat, Social Media, Walk-ins at branches, SMS / IVR requests, etc.
• To integrate with the Call Center infrastructure including CTI (Computer Telephony Integration) /Dialer and Policy Admin System. Thus, enabling real time Claim registrations and endorsements and providing a 360-degree customer view for better customer engagement.

“KGI is glad to have Talisma as their partner in customer experience management”

– Rahul Singh, Project Manager

• To manage complaints effectively and link the Integrated Grievance Management System (IGMS) to the online consumer complaints registration system of Insurance Regulatory and Development Authority of India (IRDAI). With simultaneous registration of complaints, customers should know that these will be attended quickly, raising their trust level and confidence in KGI.
• To maintain a Standard process of handling interactions through all touch points with workflow, auto-assignments and end-to-end handling in CRM. Thus, facilitating faster responses and tracking.
• To conduct CSATs and Quality audits to continuously evaluate service quality for improvement. Thus, enabling continuous learning and improving customer experience.
• To implement a CRM which had its learnings from the General Insurance industry and which required least customization and lead time, and a reasonable license cost with less number of users initially. Thus, providing scalability and cost effectiveness in the long run.
• To ensure efficiency of the  service  representatives  and for faster delivery of responses,  KGI  was  sure  that it wanted a single system which could serve their need. As this would restrict the access to Policy Admin System and avoid users navigating to multiple systems to provide resolution.

Solution Provided by Talisma

Talisma has a proven robust platform with a lot of out of the box features which enables easy integration whilst providing the ability to significantly reduce manual interventions.

Talisma has Provided KGI the following:

• Multi-Channel Capabilities – Talisma has enabled a multi-channel capability at KGI covering Email , Phone , Chat and SMS for successfully managing high volumes of inquiries received by KGI daily.
• 360-Degree View of Customer – One view of Customer for an Agent to handle different types of requests and queries by displaying data from various KGI systems.
• Service Request Workflows – Talisma has provided workflows to handle simple to complex service requests such as Contact details change, Claim intimation etc. with smooth integration with the KGI core system.
• IGMS Integration – Talisma has implemented IGMS integration for smooth flow of new complaints as well as complaint status updates between Talisma and IRDA.
• Quality Assessment – Critical for measuring quality based on parameters specific to the channels such as Chat/Email/Phone used by Agents. It provides a process to maintain systematic review for Agents/Supervisors.
• Website Queries/Feedback – All queries/feedback received by KGI on its website are created and resolved in Talisma Digital Platform .
• Knowledge Base Management – Provides a repository of data required by Agent/Supervisor with real-time access to do their job much efficiently.
• Detailed reports are provided to analyze, identify and improve processes.
• Specific reports are available that uncover patterns which are otherwise tough to see such   as performance reports for each platform, channel and the blended Agents’ data.
• Data points are presented on a dashboard  that is easy to use and can help improve customer experience and consistency of service delivery across channels. Thus, highlighting shortcomings, service mismatch, improving staff training and promoting better interactions.

Key Milestones Achieved After Using Talisma

Implementation of Talisma Digital Platform has helped in achieving consistent and positive customer experience.

• Talisma Digital Platform has helped KGI automate customer interaction management across all touch points and all modes of communication.
• Identifying needs more effectively by understanding specific customer requirements as products are mapped to individual customers in KGI’s implementation of Talisma Digital Platform.
• Workflow based and Time bound assignment of interactions to multiple departments has helped KGI improve their turn-around time drastically.
• By tracking Claim registrations in Talisma Digital Platform, that is directly integrated with KGI’s Core Policy Admin System, KGI can offer best services to its customers, when they need them.

Benefits Realized by Kgi After Using Talisma

KGI is glad to have Talisma as their partner in Customer Experience Management . Above achievements have led to consistent service quality.

• Tracking resolutions to customers’ needs has become simpler. This has helped KGI meet and exceed customer expectations.
• Automation and real time sync of service requests with KGI’s core system has helped multiply productivity, maintain quality and improve efficiency.
• 360-degree customer view provides instant access to all the requisite customer information to enable “first time right” services improving KGI’s reliability amongst customers.

Ultimately, this has led to:

• Enhanced customer satisfaction, ensuring KGI’s good reputation in the marketplace continues to grow.
• Increased value from KGI’s existing customers and reduction in cost associated with supporting and servicing customers’ needs.
• Increasing KGI’s overall efficiency and reduction of total cost of service.
• Improved service trend analysis.
• Achieved standardization across all touch points.
• Improved data availability for various Marketing campaigns.
• Transparent agent performance overview through the quality assessment module.

Why KGI Chose Talisma?

KGI had evaluated multiple CRMs and finally selected Talisma over the others for its simplicity, easy navigation and  adaptive  UI  for  all  types  of  interactions  across   all touchpoints. Thus, allowing easy functioning of representatives across processes.

At the Management level, Talisma was the closest to meeting KGI’s business requirements, implementation targets and budgets.

The Road Ahead

Post the implementation of both phases, KGI plans to start working with Talisma on Chatbot , Social  CRM , and Analytics to serve their diverse customer base having distinct demographic characteristics with an aim to strengthen loyalty through better engagement experience and customized services aligned to customer expectations.

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Insuropedia

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Read about Five recent insurance related litigations in the Supreme Court

• June 11, 2023
• securenow_insuropedia

Five recent insurance related litigations in the Supreme Court and What They Mean for Policyholders

I. Claims can be rejected if material information is not disclosed when buying insurance

Reliance Life Insurance v. Rekhaben Nareshbhai Rathod – Supreme Court litigation

This case was about a basic principle of insurance law: if the insured does not reveal important information when signing an insurance contract, the insurer can reject policy claims.

In this case, Mrs Rathod’s spouse had bought life insurance from Reliance Life Insurance in September 2009. However, Mrs Rathod had taken a life insurance policy from Max New York Life Insurance Co. Ltd. in July 2009. Reliance. After the death of her spouse, Mrs Rathod made a claim under the policy in February 2010. While Reliance was making a decision on this claim, Max informed it of the previous insurance. Because Mrs Rathod had not revealed this information, Reliance rejected her claim.

The District Commission dismissed Mrs Rathod’s complaint because of her failure to disclose information. However, both the State and National Commissions allowed the appeal noting that “the omission of the insured to disclose a previous policy of insurance would not influence the mind of a prudent insurer . ” In appeal, the Supreme Court (SC) reversed this decision. It noted that not disclosing insurance obtained earlier was the suppression of a material fact, which would allow Reliance to reject the claim. Giving a wrong answer or not revealing important facts in the proposal form cancels the policy since it goes against “good faith”.

II. Insurance company must provide all reasons for rejecting a claim in the initial rejection letter

Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and Ors. Dalbir Kaur

The SC set aside a verdict from the National Consumer Disputes Redressal Commission (NCDRC) in this case. It noted that an insurance contract is of “utmost good faith” and anyone who wants life insurance must disclose all important facts. The NCDRC had dismissed Bajaj Allianz’s plea against an order asking it to pay a full death claim with interest to the mother of the deceased. The SC bench headed by Justice D. Y. Chandrachud was hearing a plea by Bajaj Allianz against this NCDRC verdict.

The SC noted that a proposal form specifically asks about pre-existing conditions to help the insurer evaluate risk. The proposer had not revealed that he was suffering from a pre-existing illness and was vomiting blood barely a month before the issuance of policy. Alcohol abuse had caused his pre-existing ailment. The insurer did not have these details. The court decided to set aside NCDRC judgement as it did not lay down the correct principle of law.

The insured person’s mother was 70 years old and had lost the support of her son. Considering this, the court used its jurisdiction under Article 142 of the Constitution to not to recover the paid out amount.

III. Unless the insured is duly informed, exclusionary clauses are not applicable

Supreme Court ruling on Litigation in case- Saurashtra Chemicals Ltd . v.  National Insurance Co. Ltd.

Saurashtra Chemicals bought a standard fire and special perils policy from National Insurance for the coal and lignite in its factory compound. It paid an additional premium to cover the risk of loss to the stock from spontaneous combustion.

The Sick Industrial Companies Act had declared Saurashtra Chemicals  a sick unit. They had closed the factory from 17 February 2006 to 9 August 2006. It reopened on 10 August 2006. Between 11 August and 20 August 2006, a spontaneous combustion destroyed some coal and lignite . National Insurance received a notice of the loss and damage. A surveyor assessed the total loss at Rs. 63,43,679.

However, National Insurance rejected the claim saying there was no loss as specified in the policy because spontaneous combustion had not resulted in a fire.

Saurashtra Chemicals then filed a consumer complaint before the NCDRC. National Insurance responded stating:

• No claim could be paid since the loss by spontaneous combustion was not covered.
• Since Saurashtra Chemicals had closed the factory for almost 6 months, the insurance cover ceased to operate. The policy stated that insurance would end if the building that had the insured property was unoccupied for more than 30 days.
• Delay in claim by more than 30 days, violating condition no. 6(i) of the policy’s general conditions.

The NCDRC did not accept the first and second reasons. However, it found the third reason valid. It dismissed the complaint on breach of condition No. 6(i) of the policy since the insured did not submit the notice of the loss in writing within 15 days of the incident.

Saurashtra Chemicals filed an appeal in the SC. The SC noted that the rejection letter did not mention the delay as a reason for rejection. National Insurance first mentioned the delay in its reply before the NCDRC. Therefore, SC allowed Saurashtra Chemicals’ appeal.

New India Assurance Co. Ltd. v. Paresh Mohanlal Parmar- Supreme Court ruling

Mr Parmar bought a burglary and housebreaking insurance policy for 5 June 2003 to 4 June 2004 from New India Assurance for Rs. 20 lakh. During this period, there was a theft in Mr Parmar’s warehouse. He reported the theft to the police and shared the information with New India Assurance. Their surveyor visited and submitted his preliminary report. New India Assurance claimed there was no forced entry because a duplicate key had been used to open the warehouse. It rejected the claim.

The State Commission dismissed Mr Parmar’s complaint. He then went to the NCDRC. It noted that the warehouse lock was found on the street and the culprit had been convicted under Section 454 IPC. Thus, it ruled that the culprit had forced open the warehouse . It also found that New India Assurance had not made Mr. Parmar aware of the relevant terms and conditions of the policy.

New India Assurance filed an appeal in the SC. Mr Parmar argued that he had not been provided with the policy’s terms and conditions. Thus, they could not reject his claim. The SC could not find any evidence to the contrary. It noted that the insurer(s) had to prove that the insured was aware of the policy’s terms and conditions when the insurer issued the policy. The SC thus supported the NCDRC order to pay the claim.

IV. Determining whether the insured is a regular employee and the use of the contra proferentum rule

Sushilaben Indravadan Gandhi and Anr. v. New India Assurance Co Ltd and Ors.

A doctor travelling in a hospital vehicle died in an accident caused by the driver’s carelessness. The hospital’s arrangement was that New India Assurance would pay compensation for those not employed by the hospital. Workmen Compensation Act, 1923 covered the employees. The main issue, in this case, was whether the doctor was a hospital employee.

The SC first examined the hospital contract. Was it a “Contract for Service,” which suggests a relationship between equals on professional terms, or “Contract of Service,” which implies a master-servant relationship? The SC ruled that the they could not treat the doctor as a regular hospital employee. His contract clearly showed that his services were provided as an independent professional. The SC thus applied the contra proferentem  principle. This states that the exclusion clause must be read against the insurer. The SC thus allowed compensation of INR 37.6 lakh to the appellants.

The SC thus clarified the position on ambiguous policy, where the contra proferentem rule will be applied. In cases of ambiguity in the policy wording, the ruling would be against the party that has prepared the contract; in most cases, this is the insurance company.

The SC also made it clear that doctors must be considered professionals. Their terms of service were different from those of general hospital employees.

In conclusion, the five recent insurance-related litigations in the Supreme Court serve as significant reminders of the complexities and nuances within the insurance industry. These cases shed light on the importance of comprehensive policy interpretation, diligent claims handling, and adherence to contractual obligations. By closely studying these rulings on five recent insurance related litigations in the Supreme Court, insurers and policyholders can gain valuable insights into potential pitfalls, mitigating risks, and fostering a stronger foundation for fair and effective insurance practices.

Last Updated on June 11, 2023 by Aishwary Mishra

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Market Research in Insurance

John Crawley was the CEO of Sunrise Insurance Company, a leading international insurance company headquartered in Las Vegas. The company had branches all over the world. As opportunities increased worldwide, the company decided to expand its operations into all potential areas of insurance. The opening up of the insurance sector in India, especially, presented a lucrative market for the company. Sunrise Insurance therefore began to consider setting up operations in the country. Crawley called all the top executives of the company to a meeting to discuss the company's expansion plans. At the meeting, it was decided that the company should hire the services of a research organization to carry out market research on the insurance operations of various insurers in south Asia, especially India and China. It was decided to hire the services of Shanti Research Agency, located in Mumbai, to carry out the research study. Shanti Research Agency, headed by Atul Mangru Patro, had considerable experience in providing market information to companies in many industries. Sunrise Insurance Company intimated Patro of its decision to hire the services of his firm and invited him to Las Vegas for a meeting with Crawley to discuss the final details...

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