Insurance claimsClaims are a black-box to many policyholders. When they finally lodge a claim, often policyholders and their families don’t know what is happening and whether they can do something. Ironically, claims are why insurance is bought in the first place. This is perhaps why insurance regulator IRDAI has directed all insurance companies to have clear and transparent communication so that the benefits of insurance policies flow to the beneficiaries in a timely manner.

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 claim, the regulator feels. From July 1, policyholders who have made claims will get regular updates on claim status. Read on to know more.

IRDAI has told all insurers to send all communication relating to issuance and servicing of insurance policies such as proposal registration, further requirements for completing proposals and various requirements of underwriting and/or relating pre-acceptance surveys etc.

So, they have to give information about policy issuance i.e acceptance /rejection of proposals, renewal/lapse intimations/premium reminders wherever sent, bonus accrued in life insurance participating policies, value of ULIP polices, and all other information that has a bearing on servicing of insurance policy.

Expect communication either in the form of a letter, e-mail, sms or any other electronic form.

In case of health insurance, where TPAs are engaged for rendering health services, insurers have been told to ensure that all related communications such as issuance of ID card are sent either by the TPA or be carried out by the insurers on their own.

The regulator has directed insurers to also send brief messages for the purpose of enhancing insurance awareness apart from sending necessary caution messages such as not falling prey to spurious calls/offers etc and thus ensure that the interests of policyholders are protected.

In order to ensure fair and transparent claim settlement procedures, all insurers have to now notify about the status of the claim at various stages of its processing. In case of health insurance, where TPAs are engaged for rendering claims services, it is the responsibility of insurers to ensure that the status of the claim is notified to the claimant at every stage of the claim. To do that, immediately upon the intimation of the claim, a unique claims reference number will be created and notified electronically to the registered mobile number and/ or e-mail id of the policyholder/claimant.

Subsequently, at every stage of the claim processing such as calling for further requirements, or arranging for survey, communication of the final decision i.e admission or rejection or repudiation of claim, payment details such as by cheque or bank credit etc, timely notifications will now be sent to policyholder or claimant.

The notification sent to the policyholder / claimant containing the unique claims reference number can be used to track the status of the claim by the policyholders / claimants themselves through the portal or website or apps of the insurance company or any authorised electronic means.

Kayzad Hiramanek, Chief – Customer Service & Operation, Bajaj Allianz Life, said: “The most sensitive part in the lifecycle of a life insurance policy is when it comes up for claims – be it for maturity, death or critical illness / hospitalisation claims. The industry and we are attuned to the necessity of keeping the policyholder or the nominee updated during the claims process, to assure them of a hassle-free settlement process. We welcome this move by IRDAI, and are happy to add that most of these recommendations are part of our daily business routine in some form. We will further refine the claims communication process and align them to the IRDAI’s latest guidelines.”

Insurers have also directed to put in place procedures for collecting the mobile numbers and the e-mail ids of the policyholders both at the point of sale and also on an ongoing basis as part of policy servicing. This because e-mail ids and phone number records need to be with the insurer to enable hassle-free intimation. It will be the responsibility of the insurers to ensure total confidentiality of policyholders information, IRDAI has said.

Author
Kumar Shankar Roy

Kumar Shankar Roy is contributing editor with RupeeIQ. He can be contacted on contact@rupeeiq.com