IRDA needs to repeal the loophole it left in health insurance guidelines
December 29, 2014
The insured need to know the reasons for claims denial or partial settlement as well as the remedies for grievances. Will IRDA take away TPAs\' powere to recommend claim amount or wait for Bombay HC to decide?
Raj Pradhan
On 16 December 2014, hearing a PIL filed by social activist Gaurang Damani, the Bombay High Court (HC) had directed the General Insurance Company/TPA to inform the policyholder for the reasons behind rejecting the claim or partially disallowing the claim under section 12(d)(ii) of the Insurance Regulatory and Development Authority (IRDA) Health Insurance Regulations, 2013 and also the remedies available to the policyholder.
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