IRDA order to be given to insurance companies for clear reasons for rejecting claims

The insurance companies will have to give a clear reason to the policy holders for rejecting the claim. Insurance regulator IRDA has said this to all insurance companies. IRDA has asked insurance companies to be more transparent in the process of settlement of health insurance claims. Apart from this, the insurance companies have been told that if they reject a claim, then tell the policy holder a clear reason for it. IRDA has issued a circular in this regard. In this, the regulator said that it is necessary for all insurance companies to set up such procedures. Through these, the policyholder can get information about the various stages of the claim process in a transparent manner.

The regulator said, “All insurance companies will have to set up such systems so that the policyholder can get information about the status of the claim filed by the cashless treatment / insurance company / TPA on the website / portal / app or in any other electronic way. Irda said that it should have complete information from the time of application to the time of settlement of the claim.

The regulator said, “All insurance companies will have to set up such systems so that the policyholder can get information about the status of the claim filed by the cashless treatment / insurance company / TPA on the website / portal / app or in any other electronic way. Irda said that it should have complete information from the time of application to the time of settlement of the claim. According to the insurance regulator, ‘Health Insurance Claim Settlement’ has been issued to Circular Life Insurance, General Insurance and Standalone Health Insurance Companies (Third Party Administrators – TPA).

IRDA said that policyholders will have to provide all the information if they are disposing of TPA claims on behalf of insurance companies. They will also have to provide facility to track the claim status. IRDA has also asked the insurance companies to ensure that a claim should not be dismissed on the basis of just ‘prior assumption or presumption’.

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