Insurers who reject claims will be required to explain on what basis the repudiation was done.
As the number of confirmed coronavirus cases in the country spikes, insurance claims for the disease are also on the rise. While the insurance regulator has asked insurers to expedite claims settlement for COVID-19 claims, there have been some instances of the claims being rejected.
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Sources told Moneycontrol that the Insurance Regulatory and Development Authority of India (IRDAI) will seek detailed clarifications on claim rejections in case policyholders complain.
Insurers who reject claims will be required to explain on what basis the repudiation was done. Unlike other health insurance claims, some special relaxations will be provided for Coronavirus cases.
Customers can contact the Ombudsman in case their COVID-19 claim is rejected terming it as a ‘pandemic’.
“Testing and hospitalisation costs could be higher in case a patient is not admitted to a state-run hospital. Quarantine related charges are also high and we are hearing that some insurers are not ready to pay such expenses,” said an official.
As per IRDAI norms, the costs of admissible medical expenses during the course of treatment including the treatment during quarantine period will have to be settled as per policy terms and conditions.
In a regular health claim, the claims settlement officer has a check-list in place. Whatever is part of the list is approved while the rest is rejected.
However, a pre-decided checklist may not work since COVID-19 claims are new to the Indian market. Without past claims data, auto rejections may not be permitted.
Though the government will cover the hospitalisation costs in case a patient is admitted to a state-run hospital, the insured will have to pay for these expenses in case they are admitted to a private hospital and seek tests from private labs.
The insurance regulator has asked the companies to be sensitive to the needs of the policyholders.
While special COVID-19 policies have also been launched, not all of them include travel history. Hence, if someone has been to countries like China, Iran, Italy or Dubai in the past six to eight weeks, there is a high likelihood of claim rejections.
However, considering the severity of COVID-19, insurers could be directed to make basic payouts without large-scale rejections.
The customers also have a higher chance of COVID-19 related claims because IRDAI, as well as the department of financial services, will take re-cognizance of auto-rejected claims.In case an individual has just brought a health product, there would be a waiting period of 30 days for covering any infectious disease.
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