Page 46 - Insurance Times May 2019

Circular

IRDAI Circular

Information to the insurance policy- purpose of enhancing insurance awareness apart
from sending necessary caution messages such as
holders/claimants about various not falling prey to spurious calls/offers etc and thus
insurance policy services. ensure that the interests of policyholders are
protected.
Ref. No:IRDAI/CAD/CIR/PPHI/059/04/2019
c) Further, in order to ensure fair and transparent
Date:10-04-2019 claim settlement procedures, all insurers shall
notify about the status of the claim at various
1. Clear and transparent communications play a vital role stages of its processing. In case of health insurance,
in servicing of insurance policies and in ensuring that where TPAs are engaged for rendering claims
the benefits of insurance policies flow to the services, it is the responsibility of insurers to ensure
beneficiaries in a timely manner. Further, when it comes that status of claim shall be notified to the claimant
to claims, there is a need to make available a tracking at every stage of claim. The following systems shall
mechanism for policyholders so as to enable them to be put in place by all the insurance companies.
know the status of their claim/s. Therefore, the i) Immediately upon the intimation of the claim,
Authority, keeping the interests of policyholders in view, a unique claims reference number shall be
directs all insurers, in terms of Section 14(2) of the IRDA created and notified electronically to the
Act, 1999 as follows: registered mobile number and/ or e-mail id of

a) All insurers shall send all communication relating the policyholder/claimant, wherever available.
to issuance and servicing of insurance policies such ii) Subsequently, at every stage of the claim
as proposal registration, further requirements for processing such as calling for further
completing proposals and various requirements of requirements, or arranging for survey,
underwriting and/or relating pre-acceptance communication of the final decision i.e
surveys etc, wherever applicable in general admission or rejection or repudiation of claim,
insurance, information about policy issuance i.e payment details such as by cheque or bank
acceptance /rejection of proposals, renewal/lapse credit etc, timely notifications shall be sent to
intimations/premium reminders wherever sent, policyholder or claimant.
bonus accrued in life insurance participating iii) The notification sent to the policyholder /
policies, value of ULIP polices, and all other claimant containing the unique claims
information that has a bearing on servicing of reference number shall also enable tracking
insurance policy, either in the form of a letter, e- the claims status by the policyholders /
mail, sms or any other electronic from approved claimants themselves through the portal or
by the Authority. Further in case of health website or Apps of the insurance company or
insurance, where TPAs are engaged for rendering any authorised electronic means, made
health services, Insurers shall ensure that all available.
related communications such as issuance of ID card iv) Insurers are also directed to put in place
are sent either by the TPA or shall be carried out procedures for collecting the mobile numbers
by the Insurers on their own. and the e-mail ids of the policyholders both at
b) Insurers shall also send brief messages for the the point of sale and also on an ongoing basis

46 The Insurance Times, May 2019