Insurance companies will have to inform about claim settlement status to policyholders at various stages of processing from July, Irdai said Wednesday. Insurers need to adopt a clear and transparent communication policy to protect the interest of policyholders, it said in a circular. 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, it added.
“In order to ensure fair and transparent claim settlement procedures, all insurers shall notify about the status of the claim at various stages of its processing. “In case of health insurance, where third party administrators (TPAs) are engaged for rendering claims services, it is the responsibility of insurers to ensure that status of claim shall be notified to the claimant at every stage of claim,” the Insurance Regulatory and Development Authority of India (Irdai) said.
Clear and transparent communication play a vital role in servicing of insurance policies and in ensuring that the benefits of insurance policies flow to the beneficiaries in a timely manner, it added. Irdai also asked insurers — life, health and general — to send all communication about issuance and servicing of policies through letter, e-mail, SMS or any other electronic form approved by it.
“In case of health insurance, where TPAs are engaged for rendering health services, insurers shall ensure that all related communications such as issuance of ID card are sent either by the TPA or shall be carried out by insurers on their own,” the circular said. 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.
Insurers may use simple, easy to read and understand language. And wherever feasible, the communication should be in regional or local language of the place of residence of the claimants, besides English/Hindi, the authority said. “This shall be implemented by insurers with effect from July 1, 2019,” Irdai said.