InvestorQ : Do you think the insurance companies will be transparent in rejecting claims?
priya Shah made post

Do you think the insurance companies will be transparent in rejecting claims?

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Swapnil Sarang answered.
1 week ago
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IRDAI has recently directed the insurance companies to be transparent in their health settlement claim process and inform the policyholders of the reasons in case their filed claims are denied. As specified in the IRDAI (Health Insurance) Regulations, 2016, where a claim is denied or repudiated, the communication about the denial or the repudiation shall be made only by the insurer by specifically stating the reasons for the denial or repudiation, while necessarily referring to the corresponding policy conditions," IRDAI said.

IRDAI has also kept stringent orders for insurers to ensure that these companies provide policyholders granular details of the payments, disallowance made and the reasons thereof, as per the regulatory norms.

In the case of Third-Party Administrators (TPAs), if settlement of claims is made on behalf of insurers, policyholders should be notified about all the communications and location to track their claims in real-time. So, IRDAI has strictly warned the insurance companies to ensure that the repudiation of claims should not be based on presumptions and conjectures.
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