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Title: FINAL ORDER
Reference No.: IRDA/TPA/ORD/MISC/204/11/2015
Date: 19/11/2015
In the matter of M/s East West Assist TPA Pvt. Ltd.
Based on the reply to Show Cause Notice dated 22-05-2014 and submissions made during Personal Hearing Chaired by Ms. Pournima Gupte, Member (Actuary), IRDAI, on 26-06-2015 at 1500 hrs. at the office of Insurance Regulatory and Development Authority of India, 3rd Floor, Parishrama Bhavanam, Basheerbagh, Hyderabad.
Show Cause Notice dated 22nd May, 2014, (SCN) on observed deficiencies in the functioning of licensed TPA namely; East West Assist TPA Pvt. Ltd. (East West TPA / the TPA) was issued and in deference to the entity’s request a personal hearing was accorded on 26th June, 2015 . The TPA company represented by Mr. Parikshit Mahajan, Chairman & Managing Director, Mr. Neeraj Batra, Chief Executive Officer and Mr. K S Nair, Chief Administrative Officer, of East West TPA. On behalf of the Authority Mrs. Yegna Priya Bharath, Joint Director (Health), Mr. DVS Ramesh, Deputy 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 East West TPA to the issues raised in the Show Cause Notice and the decisions are as follows;
1. Charge No. 1:
East West TPA had not submitted Annual Report of their Company for the FY 2012-13 within the stipulated time Violation of Reg. 24 (2) of IRDA (TPA – Health Services) Regulation, 2001.
Reply of East West TPA:
East West TPA had submitted that their auditors did not sign the Annual report for want of TDS certificates.
2. Charge No. 2:
The TPA Company neither acknowledged nor responded to Authority e-mail dated 06-09-2013. This is not a professional manner of dealing with the matters of Regulatory Compliance issues. Further East West TPA failed to submit the document / statement / return as requested by the Authority Violation of Reg. 21 (1) to be read with Reg. 25 (3) of IRDA (TPA – Health Services) Regulation, 2001.
Reply of East West TPA:
The Authority e-mail was lost in transmission. Inconvenience is regretted and respectfully apologizes for the same.
Decision (Charge No. 1 & 2 of SCN dated 22-05-2014) :
It is observed that there was a delay in submission of annual report for the year 2012-13 by East West TPA. However, considering the submissions of the TPA the Authority do not press any charges. East West TPA is advised to strictly comply with all Regulatory requirements hereafter.
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Place : Hyderabad
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(Pournima Gupte)
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Date : 17-11-2015
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Member (Actuary)
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