Set norms for claim settlement, Irda told

The Bombay high court on Tuesday asked the Insurance Regulation and Development Authority (IRDA) when it would frame guidelines for settling insurance claims.

The directions were issued by a division bench of Chief Justice Mohit Shah and justice Roshan Dalvi, while hearing a public interest litigation (PIL) filed by social worker Gaurang Damani, pointing out the plight of about 5.50 crore consumers of medical insurance — especially, after Third Party Administrators (TPAs) stopped offering cashless medi-claim benefits.

Damani has also alleged that are no standard guidelines to settle insurance claims and it is often done at the whims and fancies of TPA.

Damani argued that TPA is not entitled to settle claims, but is found to be doing so in several cases as it receives financial incentives. There is discrimination in settling claims of individuals and of corporate clients, he claimed.

According to the PIL, problems began in July 2010 after public sector insurance companies, acting through TPAs, suddenly stopped offering cashless medi-claim benefits to consumers. The government’s data stated that on an average Rs11,000 crore is paid as premium, annually, whereas the policies are worth over Rs 26,000 crore. The court asked Damani to give a list of such instances to IRDA.