Mumbai: If you have ever filed for insurance claims and have found it to be a tedious process, by July you can expect a smoother claim settlement process. Last week, the Insurance Regulatory and Development Authority of India (IRDAI) in a circular, asked insurers – both life and general – to provide clear and transparent communications and enable a tracking mechanism. The regulator has directed all insurers to send all communication relating to issuance and servicing of insurance policies in the form of a letter, an email, SMS or any other electronic mode.
“The circular is consumer-centric and makes sure that insurers and intermediaries are transparent in servicing customers across policy wordings, issuance and claims. The issues addressed have been lack of communication on inclusions/exclusions, documents required for processing claims, timeline on servicing claims, self-service tracking not available for claims and finally rejection of proposals and reasons for the same. Insurers will now have to build these mechanisms internally to expose status at each level. The reason this has come about is due to increased complaints on ombudsman and IRDAI for non-clarity on claims rejections and service issues," said Rohan Kumar, chief executive officer, Toffee Insurance.
To ensure fair and transparent claim settlement procedures, all insurers have been asked to notify about the status of the claim at various stages of its processing. This means you will know at what stage your claim process stands. It is similar to how you track your Employees’ Provident Fund Organisation (EPFO) or even the food you order through a food delivery app.
As a part of the process, a unique claims reference number should be created and notified electronically to the registered mobile number or email of the policy holder. At every stage of the claim processing, such as calling for further requirements or arranging for survey, communication of the final decision — admission or rejection or repudiation of claim — payment details such as by cheque or bank credit, timely notifications have to be sent to the policyholder or claimant.
You can use the claims reference number to track the claims status through a portal, website, an app of the insurance company or any authorised electronic means. The regulator has directed insurers to put in place procedures for collecting the mobile numbers and the email ids of the policyholders.
“Insurers are most likely to use SMS and emails to deliver these messages, similar to the way banks inform customers about transactions. The most impact is likely to be in the claim settlement process. Claims will have the maximum impact because currently people do not hear back until the final decision is taken. Now as the claim documents move through various stages, customers will know what is happening," said Kapil Mehta, founder, Securenow.in. However, remember that it is not mandatory.
Hence, if you don’t want to share your number or email, you can refuse to provide it to the insurer.