Insurance regulator IRDAI has taken a tough stance on health insurance claims. More than half of the complaints received under the Insurance Ombudsman system relate to health insurance policies. Customers complain that insurance companies do not settle the full amount of claims.
Following increasing complaints of not receiving the full amount of health insurance claims, the insurance regulator IRDAI has now taken a tough stance. IRDAI has clearly instructed insurance companies to settle claims with honesty, transparency, and speed, as the reduction in claims is eroding customer trust. IRDAI is closely investigating why health insurance claims are not being paid in full. This issue is especially serious because more than half of all complaints relate to health policies.
On Tuesday, on the occasion of ‘Insurance Ombudsman Day’, IRDAI Chairman Ajay Seth said, “We are continuously seeing some shortcomings in health insurance.” Although the number of settled claims is high, the amount paid out is often lower than expected. He urged insurance companies to maintain honesty and transparency in claim settlements. Of the 53,230 complaints received in FY2024, 54% were related to the health insurance sector.
Accusations and Counter-Accusations
The Chairman stated that our expectations from insurance companies are clear: that claims be settled quickly, fairly, and transparently. Anything less undermines the trust on which our entire industry rests. Insurance companies claim that the decline in claim amounts is due to healthcare providers not adhering to the rates agreed with insurance companies. Hospitals, meanwhile, accuse insurance companies of questioning medical procedures.
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