Insurers settle 54% of Covid claims, 1.41 lakh cases still hanging

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 shoppers who’ve taken Covid medical insurance as of March 2021. Of whole claims of Rs 14,608 crore underneath the Covid medical insurance schemes, insurers have settled solely claims value Rs 7,900 crore, which is 54 per cent of quantity claimed by insured individuals.

On high of this, whereas 9,96,804 individuals made claims as of March 2021, insurers have solely settled the claims of 8,55,250 individuals, leaving out 1,41,554 people who find themselves but to get the cash from insurance coverage firms, based on figures out there with the Common Insurance coverage Council. This delay is regardless of insurance coverage regulator Irdai advising all basic and well being insurers to resolve on settlement of medical insurance insurance policies pertaining to Covid-19 inside two hours.

“A serious chunk of the insurance coverage claims is cashless and settled by the insurance coverage firm on the day the affected person is discharged. If 1.41 lakh sufferers whose claims are but to get the cash from the insurance coverage firm, that’s one thing that insurance coverage regulator Irdai ought to look into and challenge an advisory,” stated an insurance coverage sector official. A standard criticism from prospects is that insurers drastically reduce down the declare quantity on some flimsy causes and plenty of of them, together with public sector companies, refuse to reimburse cash to policyholders. Nevertheless, insurers stated many claims are inflated payments, which don’t come underneath the phrases and circumstances of the coverage.

As many as 66.37 per cent of whole claims underneath 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 underneath the Covid medical insurance schemes as on March 31, 2021, claims value Rs 9,744 crore have come from Maharashtra, Gujarat, Karnataka, Tamil Nadu and Delhi. Maharashtra topped the claims record 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).

Selections on cashless remedy must be communicated to the hospital inside two hours from the time of the receipt of authorisation request and the final needed requirement. Nevertheless, 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.

Throughout the 11 months ended February 2021, insurance coverage companies reported a 13 per cent enhance in medical insurance premium revenue 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, stated basic and medical insurance firms can not reject claims based mostly on “presumptions and conjectures” and must specify the explanation for denial or rejection of claims by referring to the corresponding coverage circumstances. In a round addressed to the insurers, the regulator stated, “Claims shall be processed in a clear, seamless and environment friendly method throughout the prescribed timelines.”

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