Insurance claim made easy! New IRDAI rules make process hassle-free - Here are details

In good news and relief for insurance policyholders, Insurance Regulatory and Development Authority of India (IRDAI) recently came out with new rules related to claims. The IRDAI said that clear and transparent communications play a vital role in servicing of insurance policies and in ensuring that the benefits of insurance policies should flow to the beneficiaries in a timely manner. The regulatory agency said there is a need to make available a tracking mechanism for policyholders so as to enable them to know the status of their claims. The new rules are aimed at providing various benefits to policyholders. Below are the key details of the new IRDAI circular released on April 10:

1. Now, insurance companies will have to inform a policyholder about claim settlement status to at various stages of processing from July.

2. Insurers to adopt a clear and transparent communication policy to protect the interest of policyholders

3. Need to make tracking mechanism available for policyholders so to enable them with the status update of their claims.

4. The IRDAI has asked all insurers to notify about the status of the claim at various stages of its processing in order to ensure fair and transparent claim settlement. 

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5. The same goes for health insurances, where third-party administrators (TPAs) are engaged for rendering claims services. IRDAI said that it is the responsibility of insurers to ensure that the status of claim is notified to the claimant at every stage of the claim.

6. IRDAI said that timely notifications should be sent to a policyholder or claimant at every stage of the claim processing such as calling for further requirements, or arranging for a survey, communication of the final decision i.e admission or rejection or repudiation of claim, payment details such as by cheque or bank credit etc.

7. The regulatory body has also asked all insurers across life, health and general to send communication about issuance and servicing of policies through all available means including letters, SMS,  e-mail or any other form approved by it.

8. In case of health insurance services rendered by TPAs, insurers should ensure that related communications like ID cards and other documents are sent either by the TPA or shall be carried out by insurers on their own.

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9. The companies will also have to send brief messages to customers to enhance awareness apart from sending necessary caution messages like not falling prey to spurious calls/offers.

10. Insurers may use simple, easy to read and understand language. And wherever feasible, the communication should be in the regional or local language of the place of residence of the claimants, besides English/Hindi.