Insurance Regulatory and Development Authority’s (IRDA) draft guidelines on health insurance sector has proposals that can bring clarity on many critical issues such as claim settlement, if draft guidelines finalized in its current form then it will make claim settlement a speedy process.
In its draft guidelines IRDA has proposed that within 30 days of receipt of complete documents, an insurer have to settle the claim. If the insurer, for any reasons to be recording in writing and communicated to the insured, decides to reject a claim under the policy, then it should do it within 30 days from the receipt of complete documents.
IRDA has also sought to standardize the operations of the Third Party Administrators (TPAs) who play a key role in processing the claims. As per the proposed provision TPA will have to compulsorily explain the rationale behind claim rejection.
This move of IRDA has followed the series of court decisions against the health insurers pertaining to settlement of claims. Then IRDA had promised to frame the guidelines pertaining to health insurance claims.
At present, though there are regulator mandated norms for claim settlement but in the absence of standard claim settlement norms, there have been cases where claim disbursement was delayed up to six months.
Posted by Bijay on June 5, 2012 at 4:41 pm under News.
their should be penalty on late claim settlement & delay payment of claim by TPA or Insurence company.also penalty on arising unjustified reason to settle the claim.
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