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Title: FINAL ORDER
Reference No.: IRDA/TPA/ MISC/ORD/207/09/2014
Date: 05/09/2014
In the matter of M/s E-Meditek (TPA) Services Ltd.
This is based on the reply to Show Cause Notice dated 16th May 2014 and submissions made during Personal Hearing Chaired by Sri M. Ramaprasad, Member (Non-Life), IRDA, on 1st July 2014 at 1430 hrs. at the office of Insurance Regulatory and Development Authority, 3rd Floor, Parishrama Bhavanam, Basheerbagh, Hyderabad.
Show Cause Notice on observed deficiencies in the functioning of licensed TPA namely, E-Meditek (TPA) Services Ltd. (E-Meditek TPA / TPA) was issued and in deference to the licensed entity’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 heard the submissions of the TPA company represented by Mr. Gopal Verma, M.D., Mr. B.S. Kaintura, CAO and Ms. Charu Kochar Jain C.S., of E-Meditek TPA. On behalf of the Authority, Mr. M. Ramaprasad, Member (Non-Life), Mrs. Yegna Priya Bharath, Joint Director (Health) and Mr. Bhaskar Khadakbhavi, Assistant Director (Health – TPA), were present in the personal hearing.
The submissions made by the TPA in their written replies to the Show Cause Notice issued by the Authority and also those made during the course of personal hearing were taken into account.
The findings on explanation offered by E-Meditek TPA to the issues raised in Show Cause Notice and the decisions are as follows;
1. Charge No. 1:
E-Meditek TPA had not submitted Annual Report of their Company for the FY 2012-13 within the stipulated time.
Violation of Reg. Reg. 24 (2) of IRDA (TPA – Health Services) Regulation, 2001.
Reply of E-Meditek:
E-Meditek TPA had submitted that they had sent unaudited financial statement to the Authority vide letter dated 25-05-2013.
2. Charge No. 2:
E-Meditek TPA vide letter dated 06-09-2013 confirmed that they had submitted letter dated 25-05-2013 in the matter of ‘Submission of Annual Report for the year ended on March 31, 2013’ by Trackon Couriers.
The courier consignment number given by E-Meditek TPA was not traceable from website of M/s. Trackon Couriers.
Thus E-Meditek TPA had deliberately submitted wrong / misleading information / statement to the Authority in the matter of delay in submission of their Company annual report for the year 2012-13.
Violation of Reg. 21 (1) to be read with Reg. 25 (3) of IRDA (TPA – Health Services) Regulation, 2001.
Reply of E-Meditek:
E-Meditek TPA confirmed again that the Company had dispatched the annual return to Authority through M/s. Trackon Courier.
3. Charge No. 3:
E-Meditek TPA had forwarded the annual report of their Company for the year 2012-13 on 13-08-2013. However, in two different communications E-Meditek TPA had confirmed to the Authority that they had forwarded annual report of their Company for the year 2012-13 on 12-07-2013.
Thus, E-Meditek TPA had deliberately submitted wrong / misleading information and/or statement, for two times to the Authority, in the matter of delay in submission of their Company annual report for the year 2012-13.
Violation of Reg. 21 (1) to be read with Reg. 25 (3) of IRDA (TPA – Health Services) Regulation, 2001.
Reply of E-Meditek:
E-Meditek TPA accepted that they had forwarded Audited Annual report to the Authority on 13-08-2013 and not in July 2013.
Decision (Charge No. 1 to 3) :
There was a delay in submission of annual report for the year 2012-13 by E-Meditek TPA, in view of the same all the charges mentioned above are proved. The Authority vide order no. IRDA/TPA/ORD/MISC/200/08/2014 dated 25-08-2014 had imposed penalty of Rs. 5 lakhs on E-Meditek TPA in the matter of violations observed during process of renewal of TPA license no. 006.
The licensed TPA in this case, is cautioned severely and is advised to strictly comply with all Regulatory requirements in future.
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Place : Hyderabad
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M. Ramaprasad
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Date : 01-09-2014
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Member (Non-Life)
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