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Insurance companies cannot arbitrarily dismiss insurance claims, need to give clear reasons

Indian insurance regulator Irda (IRDAI) has taken seriously the case of claim rejection from insurance policy customers. The regulator has clearly said that now insurance companies have to tell the customers clearly why their claim was rejected. IRDA has issued a circular saying that if the health insurance company rejects the customer claim, then they should explain why this happened. At the same time, they have said that customers of insurance policy should adopt more transparency in settling claims.

The information available to the customer at every stage

IRDA has stated in its circular that all insurance companies should adopt such procedures, to keep an eye on which stage their claim is in. They have to give information about each stage in a transparent manner. Insurance companies will have to create such a system so that the customer can know when their claim will be received. IRDA said that insurance companies should make such arrangements that customers can get information about their claim status through their website or app.

The claim cannot be dismissed on the basis of prior belief only

IRDA said that from applying for a claim, complete information should be given about its settlement. ‘Health insurance’ claims settlement circular life insurance, general insurance and single health insurance companies have been issued to the third party administrator ie TPA. Irda said that if the TPA is settling the claims on behalf of the insurance company, then all the information should be given to the policyholders. IRDA has asked the insurance companies to ensure that a claim should not be dismissed on the basis of prior assumption or inference. In fact, competition in the insurance sector may increase significantly in the coming days. Therefore, it can be difficult for insurance companies who are lagging behind in showing transparency in claim settlement.