IRDAI has asked all insurance companies to be more transparent in the claims settlement process with clients.
Insurance companies have to make sure a proper online tracking system is in place for consumers to track their status of claims. The tracking system will cover details from the time of claim request till the disposal of the claims.
“It is essential that all insurers establish procedures to let policyholders get clear and transparent communication at various stages of claim processing. All the insurers shall ensure putting in place systems to enable policyholders track the status of cashless requests/ claims filed with the insurer/third party administrators through the website/portal/app or any other authorized electronic means on an ongoing basis. The status shall cover from the time of receipt of request to the time of disposal of the claim along with the decision thereon,” said IRDAI.
IRDAI said insurance policyholders should be notified with all the communications as well as location to track the claims in case claims are being settled by TPAs on behalf of insurers.
Insurance companies have to state clear reasons for rejection of insurance claims. “Insurers shall also ensure that the policyholder is provided with granular details of the payments made, amounts disallowed and the reasons for the amount disallowed,” said the regulator.