The Insurance Regulatory and Development Authority of India (IRDAI) has introduced comprehensive regulations to protect policyholders' interests and ensure transparency in the insurance sector. These rules mandate specific timelines for claim settlement, grievance redressal, and clear communication, creating a fair and efficient system for both insurers and policyholders. Below is a detailed explanation of the key regulations issued by IRDAI.

1. IRDAI (Protection of Policyholders’ Interests) Regulations, 2017
   1. Timelines for Claim Settlement:
      • Insurance companies must process and settle claims within 30 days of receiving all required documents.
      • If an investigation is required, the insurer must complete the process within 90 days of receiving the claim intimation.
      • Post-investigation, payment or rejection must be communicated within 30 days.
   2. Claim Denial:
      • If a claim is denied, the insurer must provide written reasons to the policyholder or nominee.
   3. Interest on Delayed Payment:
      • If a claim is not settled within the stipulated time, the insurer must pay interest at 2% above the bank rate from the due date.
2. IRDAI Health Insurance Regulations, 2016
   1. Cashless Claims:
      • In health insurance, insurers must settle cashless claims directly with the hospital within 24 hours of receiving all documents.
   2. Pre-Authorization:
      • Pre-authorization for cashless claims must be granted (or denied with reasons) within 6 hours for emergency cases.
   3. Reimbursement Claims:
      • Reimbursement claims must be settled within 30 days after document submission.
3. IRDAI (Third-Party Motor Insurance) Regulations
   • Insurers must settle third-party motor insurance claims within 30 days of receiving the final surveyor report and required documents.
   • The claims process includes appointing a surveyor for damage assessment within 48 hours of receiving intimation.
4. IRDAI Ombudsman Rules, 2017
   • Policyholders can approach the Insurance Ombudsman if their grievance about a claim settlement remains unresolved for more than 30 days.
   • Ombudsman decisions aim to provide faster resolution, often within 3 months of filing the complaint.
5. Grievance Redressal via IRDAI’s IGMS
   • Defined Timelines: Avoids unnecessary delays and protects policyholder rights.
   • Documentation Clarity: Insurers must provide clear information on required documents.
   • Policyholder Education: Insurers are obligated to educate customers about the claims process, terms, and exclusions during policy issuance.

How IRDAI Regulations Ensure Transparency

• Defined Timelines: Avoids unnecessary delays and protects policyholder rights.
• Documentation Clarity: Insurers must provide clear information on required documents.
• Policyholder Education: Insurers are obligated to educate customers about the claims process, terms, and exclusions during policy issuance.