Insurers have to update claimants of processing status.
Chennai: The insurance regulator has asked insurers to share status of claims at various stages of their processing with the claimants to ensure a fair and transparent claim settlement process. This has to be implemented by the insurers from July 1, 2019.
"Clear and transparent communications 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. Further, 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," IRDAI said.
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 settlement process.
Immediately upon the intimation of the claim, a unique claims reference number shall be created and notified electronically to the registered mobile number or e-mail id of the policyholder/claimant.
At every stage of the claim processing timely notifications shall be sent to policyholder or claimant. The notification sent to the policyholder / claimant containing the unique claims reference number shall also enable tracking the claims status by the policyholders / claimants themselves through the portal or website or apps of the insurance company.
Mobile numbers and the e-mail ids of the policyholders should be collected both at the point of sale and also on an ongoing basis as part of policy servicing. Providing mobile number and e-mail ids by a policyholder shall be voluntary and shall not be made mandatory. Services shall be made available to enable the policyholders to update their mobile numbers and e-mail ids. It will be the responsibility of the insurers to ensure total confidentiality of policyholders' information.
IRDAI also directed insurers that consent of the policyholders shall be specifically obtained for notifying the services rendered by the insurers and no other unsolicited information shall be sent to the policyholders.
The communication also should be made in simple language that is easy to read and understand. Wherever feasible, the communications may be in regional or local language, besides English/Hindi.