At a time when the nation is witnessing the second wave of the Covid pandemic, insurance coverage firms have settled solely 54 per cent of the claims obtained from the purchasers who’ve taken Covid medical insurance as of March 2021. Of whole claims of Rs 14,608 crore beneath the Covid medical insurance schemes, insurers have settled solely claims price Rs 7,900 crore, which is 54 per cent of quantity claimed by insured folks.
On prime of this, whereas 9,96,804 folks made claims as of March 2021, insurers have solely settled the claims of 8,55,250 folks, leaving out 1,41,554 people who find themselves but to get the cash from insurance coverage firms, in line with figures out there with the General Insurance Council. This delay is regardless of insurance coverage regulator Irdai advising all basic and well being insurers to determine on settlement of medical insurance insurance policies pertaining to Covid-19 inside two hours.
“A major chunk of the insurance claims is cashless and settled by the insurance company on the day the patient is discharged. If 1.41 lakh patients whose claims are yet to get the money from the insurance company, that’s something that insurance regulator Irdai should look into and issue an advisory,” mentioned an insurance coverage sector official. A standard grievance from prospects is that insurers drastically reduce down the declare quantity on some flimsy causes and lots of of them, together with public sector companies, refuse to reimburse cash to policyholders. However, insurers mentioned many claims are inflated payments, which don’t come beneath the phrases and situations of the coverage.
As many as 66.37 per cent of whole claims beneath the Covid medical insurance insurance policies are from 5 states, with Maharashtra accounting for the utmost variety of claims. Of whole claims of Rs 14,608 crore beneath the Covid medical insurance schemes as on March 31, 2021, claims price Rs 9,744 crore have come from Maharashtra, Gujarat, Karnataka, Tamil Nadu and Delhi. Maharashtra topped the claims checklist with 3.58 lakh claims for Rs 4,345.39 crore, adopted by Gujarat (1.30 lakh claims for Rs 1,922 crore) and Karnataka (75,938 claims for 1,136 crore).
Decisions on cashless remedy should be communicated to the hospital inside two hours from the time of the receipt of authorisation request and the final obligatory requirement. However, figures reveal {that a} good variety of prospects are but to get the cash from insurers regardless of the advisory of Irdai about reimbursement in two hours.
During the 11 months ended February 2021, insurance coverage companies reported a 13 per cent enhance in medical insurance premium earnings to Rs 52,886 crore. Of this, retail prospects accounted for Rs 22,909 crore and group insurance policies amounted to Rs 25,540 crore.
The insurance coverage regulator had, on March 20, mentioned basic and medical insurance firms can not reject claims based mostly on “presumptions and conjectures” and need to specify the explanation for denial or rejection of claims by referring to the corresponding coverage situations. In a round addressed to the insurers, the regulator mentioned, “Claims shall be processed in a transparent, seamless and efficient manner within the prescribed timelines.”
