‘Insurers must tell aggrieved clients whom to approach’

By: | Updated: December 17, 2014 10:02 AM

Bombay HC asks IRDA to direct insurance firms to inform aggrieved mediclaim policy holders about the available remedies...

Social worker Gaurang Damani, in his public interest litigation, sought directions to insurance companies to come out with a pre-packaged compensation for policy holders. (Thinkstock)Social worker Gaurang Damani, in his public interest litigation, sought directions to insurance companies to come out with a pre-packaged compensation for policy holders. (Thinkstock)

The Bombay High Court on Tuesday asked the Insurance Regulatory Development Authority (IRDA) to direct insurance firms to inform aggrieved mediclaim policy holders about the available remedies and authorities that can be approached.

These instructions are supposed to be a part of the policy being offered by insurers, the Court said.

The court also asked the firms to give medical reasons for denial of claim to people, according to Health Insurance Regulations, 2013. So far, insurers have been offering “reasonable and customary” explanation as the reason in the claim settlement letter.

Social worker Gaurang Damani, in his public interest litigation, sought directions to insurance companies to come out with a pre-packaged compensation for policy holders. The Irda has informed the court that the pending issues in new health regulations will be taken up seriously with insurance firms.

The petitioner submitted before Chief Justice Mohit Shah and Justice BP Colabawalla copies of health insurance data he received from the website of Insurance Information Bureau. The data for 2012-13, shows a drop of 32 per cent in claims settled by insurers since ‘cashless’ facility being offered  to undergo treatment in hospitals, was stopped.

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