Bajaj Allianz General Insurance Hiring for Zonal Incharge Specialised Claims HO at Kumardungi, Jharkhand, India

j Job Purpose

Considering diverse court cases/litigations other than TP cases at different forums/courts pertaining to different claims department, disputes on different variety of insurance products/contracts which involved critical and product specific technicalities, a separate vertical was created within claim legal team to handle all such court litigations. Leading a Central team at Head office, leading Hub Managers Specialized Claims Hub coordinators/ Legal officers handling specialized claims at Region/Zone and taking all final decisions at head office pertaining to all specialized claims and litigations including decision in regards to cases fit for compromise or defense/contest, giving quantum approvals for compromise cases, decision on line of contest and evidence, decision on awards either to satisfy or to prefer an appeal etc etc.

Responsible for payment approvals in system, Reserve adequacy, increasing success ratio, refund of amount, controlling/managing execution, warrant, arrest warrant.

Further, responsible for relevant data and report required for regulatory (IRDAI) /statutory/ Protection of Policy holders Committee (PPC) and audit compliance.

Principal Accountabilities

Specialized Claims Litigation Management: –

• Responsible for management and handling of specialized claims litigations of more than 5000 including Appeals pending before various courts of more than 230+ courts in North Zone e.g District Consumer Commission; State Commission, National Commission, Supreme Court of India, High Courts, Insurance Ombudsman, Civil Courts, WC Courts with the reserve of more than 100 Crs and Bulk litigations reported post Natural catastrophic (NAT/CAT) losses with financial liability in Crores.
• Responsible for litigation Management of Specialized Claims litigation in North Zone with teams of 3 team members and more than 230 advocates.
• Responsible for approval of Self-Contained Notes (SCNs)/Reply (WS)/Affidavit/evidence/Written Arguments to be filed before the various courts for proper defense/compromise in the matter.
• Responsible to ensure to comply/file documents/affidavit/evidence/Appeal/Stay compliance within prescribed statutory time limit and also responsible for evaluation of complaint, retrieval and scrutiny of claims documents, Enquiry into the claim, Evaluation of the technicalities involved, merits, evidentiary value, law points and arriving on logical decisions.
• Responsible for improving Success ratio in favor of the company and to ensure decision of repudiation of claims get approved/upheld by the court of law.
• Responsible for Refund of amount/recovery from various forums, Courts.
• Responsible to avoid any execution/attachment warrant/arrest warrant from court against company officials.
• Responsible for initiative for quality, process improvement, improve efficiency, reduce TAT, cost saving, provide data insights, technical and legal training & skill development program
• Responsible for automation in specialized claims, system development, module development
• Responsible to advice on non-litigation cases and draft approvals in repudiation cases and expert advice in non-litigation cases on referral.

Statutory Compliance-Report submission: –

• Responsible to submit ‘IRDA Form 2’ data/report; Consumer affair department (CAD) Report on Monthly basis
• Responsible to submit ‘Protection of Policy holder’ (PPC) and ‘Root cause analysis’ (RCA) Report on quarterly basis

Appeal litigation management/Writ Petition/Critical Issues: –

• Responsible to handle Appeals cases of specialized claims and litigation before court including State Commission PAN India, National Commission, High Courts PAN India; Supreme Court of India and to ensure maximum favorable order in pending litigation in appeal from appellant court as any order from higher court effect all pending litigation in relation to entire industry.
• To ensure effective management of writ petitions pending before various High Courts challenging policy decision of Govt in relation to insurance specially Agri Business

Co-ordination with internal departments: –

• Responsible for Co-ordination with other department like health, travel, Motor, Agriculture, ILM, U/W Operation, Marketing, Non-motor, etc and also responsible to provide guidance and support to other departments and other internal and external customers with respect to decision of claims reported; opinion on admissibility of claims, survey assessment also responsible for creation of SOPs/SLAs for Claims Legal and collaboration with LOBs for best results.

Team development and Vendor Management: –

• Responsible for selection for suitable talent for team and to provide development opportunities for team members to enhance technical knowledge and build domain expertise. Also responsible for to nurture new vendors/advocates and build a domain expert team to increase success before courts.

Customer Grievances

Responsible for replying customer grievances in the spl claims addressed to Higher authorities of the company with in TAT

MAJOR CHALLENGES

(Challenges faced on an on-going basis in carrying out the job)

Major Challenges are below: –

• Diversity of litigations pertaining to different Insurance products before courts situated at different geography Pan India.
• Litigation by unsatisfied customers/Insured alleging deficiency on part of the company including deficiency of service.
• Bulk litigations by customer pertaining to catastrophic events; Agriculture Insurance.
• Frivolous litigations by notorious customers to harass the company employees, malign the image of the company, sending/posting negative comments on social media in pending litigations cases etc.
• Long tail of litigations due to various reasons like challenging the decision by unsatisfied customer before appellants courts, lack of infrastructure, backlog and vacancies of judges, support staff causes, non-judicial person selected as judges and increasing additional interest liability.
• Pro customer-oriented approach of Consumer courts effects the success ratio and increases the financial burden
• Time bound decision. Compliance with limited manpower and human resources with vast geography at PAN India.
• Non- compliance of court order amounts to criminal offence which has a repercussion of arresting senior and TOP management people.
• Challenges arising due to change in law e.g. increasing pecuniary jurisdiction of lower courts, power to impose fine, ban on service or product. Lack of good technically sound advocate at lower courts is major challenges.
• Getting refund from Various courts/Consumer forum and apex courts is another challenge.
• Consumer Court also tends to pass negative remark against company in order and negative media reporting of the same is also a challenge.
• Lack of IT System, management of litigation/data manually is major challenges.
• Management of data for submission of statutory reports
• Co-ordination and dependency on other department for documents, files, evidence
• Judgement from 35 State Commission, 25 High Courts, 1 National Commission and 1 Supreme Court have binding impact on pending litigation at different geography.

Decisions

• Decision on reserve adequacy in consultation with concerned claims department
• Decision/approval of WS; Reply; SCN; Affidavits; Arguments; Appeal; Writ Petitions; Special leave Petitions (SLP); Appeals etc
• Decision/evaluation of evidence/expert witness to be examined before Courts.
• Decisions in specialized claims either to contest or to Compromise and decision on award in order to comply or to file appeal before higher forums/Higher judicial authorizes based on merits of Case.
• Decision on Awards/Order passed against company by State Commission, National Commission, High Courts, Supreme Courts and decide liability of company.
• Decision on stay orders, compliance on stay order including to decide deposit amounts before Courts.
• To take decision to appoint advocate including Sr Advocates in critical claims before courts including National commission and Supreme Court of India based on nature of complexity of matter, to decide fees and approval.
• Decisions in payment approvals and calculations of amounts for compliance.
• Decision on execution petition/warrant/arrest warrant etc
• Decision on refund amount pending before court
• To take decision of empanelment or deplanement of advocates
• Decision and strategy making to minimize finical implication on company due to change in law or judicial pronouncements

Educational Qualifications

• Qualifications

Minimum qualification required: L.L.B.

Work Experience

• Minimum 10 to 15 years of experience in the insurance industry
• Sound understanding of insurance industry and Governing laws.
• Good Negotiation Skills, Relationship Management, Team building Capability.
• Experience in managing specialized claims litigation, consumer litigation, Ombudsman matters from lower courts to Amex Courts including National Commission litigation; Supreme Court litigation
• Experience in managing/handling Arbitration litigation
• Experience in preparing brief for Sr Advocate and briefing Sr Advocate.
• Experience in managing/handling Police, Warrant, Govt officials including Insurance Ombudsman etc
• Experience in statutory compliance