Delay in settlement of your #mediclaim by health insurance company? Know your rights.

Delay in settlement of your #mediclaim by health insurance company?  

Know your rights.

As per Section 16 of "Protection of Policyholders' Interest Regulations, 2017",

Every Health Insurance Company is required to initiate & complete the investigation (Process the claim papers) within '30 days' 

and 

settle the claim (full/partial) within '45 days' from the receipt of last necessary documents from Customer (hospital bills & other reports/certificates). 

In case of delay beyond stipulated '45 days' the Insurance Company shall be liable to pay interest at a rate of 2% above the bank rate from the date of receipt of last necessary document to the date of payment of claim.

Make sure to mention this in your Complaint letter when you Complaint to grievances cell of your insurance company in case of delay.

Insurance Ombudsman:

If your Insurance Company does not solve your complaint within 30 days.

- You can complaint to 'Insurance Ombudsman'  by writing a simple complaint on Plain paper. 

- No fees / charges are required to be paid. 

- Insurance Ombudsman will act as a mediator.

- The award/order of Insurance Ombudsman shall be binding on the Insurance Company. 

- The Insurance Company shall comply with the Order/Award within 30 days from the date of receipt of the Order/Award and intimate of its compliance to the Insurance Ombudsman

(As per Insurance Ombudsman Rules, 2017)

Read here complete Insurance Ombudsman Process:

https://www.policyholder.gov.in/Ombudsman.aspx

FAQs on Insurance Ombudsman Process (one page):

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3157&flag=1

Download PDF (12 pages) of 

"Protection of Policyholders' Interest Regulations, 2017":

https://www.policyholder.gov.in/uploads/CEDocuments/PPHI.pdf

Other Laws governing General Insurance Industry:

-The Insurance Regulatory and Development Authority (IRDA) Act, 1999

- The Insurance Rules, 1939

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Disclaimer:

These guides are not legal advice, nor a substitute for a lawyer. These articles are provided freely as general guides for legal awareness in the Sociey. Laws are updated/amended regularly by concerned authorities. Please check for latest & updated laws with your legal advisor.