Irdai directs insurers to share status of claims with policyholders

The insurance regulator has directed insurers to share status of claims at various stages of their processing to ensure a fair and transparent claim settlement process. This has to be implemented by the insurers from July 1, 2019.

“When it comes to claims, 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 Irdai said on Wednesday.

In case of health insurance claims, where third party administrators (TPAs) are involved in rendering claims services, the insurance companies have to make sure that status of claims of policyholders are notified to them at every stage of the claim sttlement process.

However, the consent of policyholders has to be obtained by insurance companies for notifying the services rendered by the insurers and no other unsolicited information can be sent to the policyholders.

The insurance companies also have to create a unique claims reference number and notify the policyholders electronically via their registered mobile number or through an e-mail as soon as the claim intimation process begins.

Moreover, the Irdai has said that the unique claims reference number should also enable tracking of the claim of the claimant through the portal or website, or apps of the insurance company, or any authorized electronic means.

The regulator has also asked the insurers to collect mobile numbers and e-mail ids of policyholders during the sale process or later to provide better service to the policyholders. However, it is up to the policyholders if they want to provide their mobile numbers and e-mail ids. It cannot be made mandatory.

Moreover, all insurers (life, general and health) have to send all communications regarding policy issuance, servicing of insurance policies to their policyholders.

In general insurance, information about policy issuance like acceptance, rejection of proposals, renewals, lapse intimations and premium reminders have to be sent to policyholders.

For life insurance, bonus accrued in life insurance participating policies, value of ULIP polices, and all other information that has a bearing on servicing of insurance policy have to be provided by insurers either in the form of a letter, e-mail, or SMS.

As far as health insurance is concerned, all communications such as issuance of ID card are either sent by the third party administrators or the insurers themselves should be communicated by the insurance company to the policyholders.  

“Care may be taken to use simple language that is easy to read and understand in these communications. Wherever feasible, the communications may be in regional or local language of the place of residence of the policyholder/claimant, besides English/Hindi,” said Irdai.

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