The Insurance Regulatory and Development Authority of India (IRDAI) has conducted inspections at eight general insurance companies, including New India Assurance, ICICI Lombard General Insurance, and HDFC ERGO General Insurance, among others. The inspections aimed to review adherence to the Health Master Circular, a directive that streamlines health insurance processes. However, the regulator identified notable shortcomings in health claim practices, including inadequate adherence to the master circular, claim rejections, unwarranted deductions, and delayed settlements.
The affected companies, which include both private and public sector insurers, may face regulatory actions, including enforcement actions, financial penalties, and requiring insurers to refund amounts to affected policyholders with applicable interest. The IRDAI’s inspection is one of the most extensive examinations in the health insurance sector this year, highlighting the need for insurers to improve their service and address consumer complaints related to claim processing.
In response to the identified lapses, New India Assurance clarified that the regulatory reviews aim to strengthen operational standards and compliance across the insurance sector. The insurer emphasized its adoption of the Master Circular and highlighted the corrective actions taken, including simplifying the Customer Information Sheet and implementing a product management panel member on the Claims Review Committee.
Similarly, ICICI Lombard noted that the IRDAI’s inspections focused on sector-wide challenges in implementing new health-related guidelines and confirmed its robust compliance and governance standards. The inspections and subsequent actions demonstrate the regulator’s commitment to ensuring adherence to regulatory standards and protecting consumer rights. The IRDAI’s stringent approach may lead to significant implications for the insurers involved, affecting their compliance records and service standards.
The review highlights ongoing challenges insurers face in maintaining compliance and ensuring efficient service delivery. The IRDAI’s oversight aims to safeguard consumer interests and ensure that insurers adhere strictly to the guidelines set forth in the Health Master Circular. As the insurance sector continues to grow, the regulator’s efforts to enforce compliance and improve service standards will be crucial in maintaining consumer trust and confidence in the industry.