The Bombay High Court has suggested Insurance Regulatory and Development Authority (IRDA) to set up an ombudsman to address insurance related grievances of consumers.
The suggestion was made by the HC while hearing a Public Interest Litigation (PIL) pointing out the hardships being faced by medi-claim policyholders.
HC said that IRDA should consider setting up a forum or an ombudsman to look into the insurance related complaints, instead of dragging such cases to court or consumer forum.
In reply, IRDA said that draft guidelines have been prepared for settling of insurance claims and it will be placed before its board for consideration.
The PIL alleged that there were no standard guidelines to settle insurance claims and it was often done at the whims and fancies of Third Party Administrators (TPAs).
The PIL argued that, TPAs are not entitled to settle claims, but are found to be doing so in several cases. PIL also said that TPAs receives financial incentives to reduce claim ratios. And there was discrimination in settling insurance claims of individuals and that of corporate clients.
According to the PIL, problem began in July 2010, after public sector insurance companies, acting through TPAs, suddenly stopped offering cashless medi-claim benefits to consumers in top hospitals in the metros.
Earlier, over 1,500 hospitals use to offer cashless policy claims and there was no need for a patient to bother about paying cash while undergoing treatment as it would be settled by the insurance company.
The scheme was withdrawn as many irregularities were found in it./// December 14, 2012 by Akanksha
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