Indian regulator IRDAI asks insurers to expedite COVID-19 claims

The Insurance Regulatory and Development Authority of India (IRDAI) has issued a new guideline to all general and health insurers to expedite the settlement of all COVID-19-related claims, with a timeline of within two hours.

The regulator said that it has taken these actions in light of the prevailing conditions owing to COVID-19, while also taking into consideration the need for alleviating the pressure on the healthcare infrastructure.

"All the insurers shall decide health insurance claims expeditiously," IRDAI said in a circular. "In order to ensure all health insurance claims are responded to quickly, insurers are directed to comply with the following timelines:

"Decision on authorisation for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorisation request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.

"Decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier."

The regulator also advised insurers to issue appropriate guidelines to their respective third party administrators.

Additionally, it has directed that the policyholders whose health insurance and motor vehicle third party insurance policies fall due for renewal during the period on and from the 25th March, 2020 up to the 3rd May, 2020 and who are unable to make payment on time are allowed to make such payment to their insurers on or before 15th May, 2020 to ensure continuity of cover.