M/s. ICAN Health Services Private Limited, (hereinafter referred to as ‘the company’) with Registered Office at A-9/2 Meera Nagar, North Main Road, Koregaon Park, Pune 411 001, was granted TPA-Health Services License No. 14 under TPA-Health Services Regulations 2001 for a period three years from 21st March 2002 to 20th March 2005. The operating office of the company is located at 101, Naina Gracias Plaza, 1st Floor, Opp. Fatima Convent, Above Kitchenette, Margo 403601, Goa.

Several Complaints were received against ICAN Health Services Private Limited pointing out irregularities and deficiencies in their functioning. The Authority therefore appointed Mr K J Prabhakar to inspect the records of the company and submit report. The inspection report of Mr K J Prabhakar brought out following irregularities and violations of IRDA – (Third Party Administrators- Health Services) Regulations, 2001:

• Breach of code of conduct prescribed by the said Regulations more particularly Regulation No 21(1) relating to professional conduct and Regulation No. 21(2) relating to the duties, obligations and responsibilities of the TPA and is officers, employees and representatives.

• Breach of Regulation 3(4) of the IRDA (TPA - Health Services Regulations, 2001) with regard to maintaining of working capital.

• Unauthorized alteration in the Character and ownership of the company since the grant of license in violation of Regulation 14(3).

• Causing this financial condition of the company to deteriorate to such an extent that it cannot function effectively thus providing a cause of action for revocation or cancellation of licence under Regulation 14(2).

• The company is functioning improperly and against the interests of insurers and policy holders thus providing a cause of action for revocation or cancellation of licence under Regulation 14(1).

The Authority, therefore vide its letter dated 22nd August, 2005 appointed Shri. J.P.Jain as the enquiry officer to conduct an enquiry in the matter. Mr. Rashid Souza, on behalf of ICAN Health Services Private Limited, participated in the enquiry and had the opportunity of making submissions and presenting documents.

The company applied for renewal of its licence expiring on 20th March, 2005. To facilitate the enquiry, the licence of the company was provisionally renewed/ extended up to 20th December, 2005 and the company was also directed not to enter into any fresh contract with insurance companies.

As per directions of the Enquiry Officer, during the course of the enquiry proceedings, a copy of the Investigation report was made available to the company. Shri J.P. Jain Enquiry Officer, on the completion of enquiry, submitted his report dated 14th November, 2005 and holding that the following charges were fully established:

1 That M/s ICAN Health Services Pvt. Ltd has breached the code of conduct prescribed by Regulation 21(1) and 21(2) of the TPA Health Services Regulations, 2001 by not following the guidelines/directions issued by the Authority.

2 That it breached Regulation 3(4) of the IRDA (TPA-Health Services Regulations, 2001) with regard to maintaining of working capital.

3 That character and ownership of the company has changed significantly since the grant of licence, which is violation of Regulation 14(3).

4 That the Financial condition of the M/s ICAN Health Services Pvt. Ltd. has deteriorated and that it cannot function effectively which is violation of Regulation 14(2).

The enquiry officer held the following charge as partly established.

5 That M/s ICAN Health Services Pvt. Ltd. are functioning improperly and against the interest of the Insurance Company and policyholders, which is a violation of regulation 14(1).

A Copy of the enquiry report was made available to the company. An opportunity was also given to the company to make submissions before Member of the Authority on 6th of January, 2006. The company did not present themselves on that date and requested for a revised date. On the revised date of 30th of January, 2006, the company did not present themselves through a representative.

The inspection report, enquiry report, submissions and the documents on record have been carefully examined and Authority is satisfied that the charges as enumerated in 1 to 5 above against the company have been established to the extent they have been upheld by the enquiry officer in his report.

In view of the foregoing and having regard to the nature and the gravity of the charges as established, the application for renewal of TPA Health Services License No. 14 of M/s. ICAN Health Services Private Limited is hereby declined.

/sd./
(C. S. Rao)
Chairman