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Insurance Samadhan Extenuating Insurance Grievances

Insurance Samadhan (InSa) was established in 2018 with the mission of addressing issues within the insurance sector such as mis-selling, fraud, and claim rejections across life, health, and general insurance policies. Founded by a team of five dedicated individuals, InSa is committed to empowering policyholders who have been wronged and ensuring they receive their rightful insurance claims or premium refunds.

Utilizing a cutting-edge algorithm, InSa identifies legitimate complaints and claims based on a comprehensive set of 80-100 parameters, a number that continues to expand through the application of machine learning techniques. This innovative approach distinguishes InSa as a leader in the industry, prioritizing efficiency and accuracy in resolving insurance grievances.

At the National Conference on Innovation and Entrepreneurship & Startup Summit held at IIT Delhi, Shilpa Arora, Co-founder & COO, and Ravi Mathur, Co-founder & CTO of Insurance Samadhan, were honored to accept the prestigious “Startup of the Year” award. In an exclusive interaction with The Interview World, they emphasized InSa’s dedication to promptly and effectively addressing the challenges faced by policyholders, highlighting the pivotal role the company plays in revolutionizing the insurance landscape.

Q: What specific challenges within the insurance sector does Insurance Samadhan aim to tackle, and how does it approach resolving them?

A: In the realm of life insurance, we encounter instances of miss-selling, where policies are sold under misleading circumstances. For instance, when applying for a loan, customers are often coerced into purchasing unnecessary policies. This is fueled by fraudulent practices, where individuals with access to your data claim that your existing policy has lapsed, prompting you to buy another policy with promises of reclaiming your money. Such deceptive tactics, including enticing offers of gold coins or foreign travel, contribute significantly to market mis-selling.

Additionally, amidst the surge of COVID-19, there has been a notable increase in death claims. However, many of these claims face rejection due to minor discrepancies, such as undisclosed pre-existing conditions or occupation details. Often, consumers are unaware of these requirements, exacerbating the issue.

Moreover, in general and health insurance, there’s a prevalent problem of claim deductions. Customers are frequently left in the dark about the deductions made to their claims, leading to frustration and confusion. Furthermore, delays in claims processing and unresponsiveness from insurance companies only compound the problem.

In response to these challenges, we offer assistance to affected individuals. We aid customers in properly articulating their complaints, addressing the gap between their understanding and the insurer’s requirements. This gap necessitates a comprehensive understanding of medical terminology and insurance policies. While regulatory bodies like IRDAI provide support, bridging this divide often requires significant effort. Many individuals struggle to effectively communicate their case, resorting to emotional pleas rather than substantiated arguments.

In essence, we aim to bridge the divide between consumers and insurers, ensuring that legitimate claims are acknowledged and processed promptly.

Q: What technologies are employed to facilitate the analysis of gaps in insurance policies?

A: Insurance, essentially, is a complex product. With numerous intricate data points embedded within policies, it often appears daunting to the average person. Our approach involves leveraging technology to simplify this complexity. Through our innovative system, we analyze insurance documents, extracting pertinent data crucial for evaluating claims.

Upon uploading your insurance document or utilizing our scanning app, our system meticulously dissects the policy, identifying key data points. We’ve integrated chatbots and IVRs into our platform, streamlining the claims process. These tools prompt users with straightforward questions regarding their specific claim scenarios.

Whether it’s a claim delay, short settlement, or miss-selling issue, our chatbot navigates users through tailored questionnaires. By gathering information progressively, our system accurately assesses the validity of each claim. We recognize that laymen may struggle to articulate their problems concisely, often expressing emotions rather than specifics. However, our system adeptly interprets these nuances, transforming them into actionable data for decision-makers.

Over the span of five years, we’ve refined and optimized our system. Today, it autonomously handles nearly 100% of health insurance cases and around 80% of life insurance cases. Through this technology-driven approach, we’ve revolutionized the claims process, ensuring efficiency and accuracy for all stakeholders involved.

Q: What is the overarching business model that your organization is currently implementing, and could you provide an in-depth explanation of its key components and strategies?

A: Our business model operates on a straightforward premise. First, when we receive a legitimate claim through our technological platform, we meticulously examine the policy. If the claim meets our criteria, we proceed to accept it, accompanied by a Rs. 500 registration fee. This fee serves as a commitment from the customer and signifies the initiation of our service journey.

Subsequently, upon the customer receiving the claim amount in their bank account, we levy a 15% charge. This fee is essential as it represents a portion of the recovered money, which would have otherwise been lost to the customer. Consequently, customers are generally content to pay this success fee, recognizing the value we bring to the table.

In essence, our operation functions on a success-based model, where our fees are directly linked to the successful resolution of claims, ensuring alignment of interests between us and our customers.

Q: What is the vision for Insurance Samadhan’s growth and development five years from now, and what strategic initiatives are in place to achieve this vision?

A: Our primary goal is to ensure that every insurance policyholder nationwide can effectively communicate their concerns and address any grievances they may have with their insurance. We aim to empower policyholders to understand the contents of their insurance documents, ensuring transparency in what they are purchasing. This is crucial because insurance is essentially a promise, a contract meant to protect individuals when they need it most. The true value of the product emerges when a claim is made, and policyholders mustn’t be met with surprises or discrepancies at that critical moment.

Our mission is to bridge the gap between what is promised and what is delivered, thereby upholding the integrity of the insurance ecosystem. By doing so, we ensure that the purpose of insurance – to safeguard individuals in times of need – is fulfilled. This overarching objective drives our commitment to reach every insurance policyholder across the country.

Insurance Samadhan – A Pioneering Startup in Addressing the Challenges of Insurers
Insurance Samadhan – A Pioneering Startup in Addressing the Challenges of Insurers
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