IRDA GUIDELINES TO INSURANCE COMPANIES ON COVID-19 CLAIMS

Due to the outbreak of Coronavirus (Covid-19), India’s insurance regulator, the IRDA (Insurance Regulatory and Development Authority) has issued instructions to insurance providers on matters related to insurance claim settlement for those affected by the deadly virus. The instructions were issued on vide circular dated 4th of March, 2020 under the provisions of Section 14 (2) (e) of IRDA Act, 1999.

Through these guidelines, IRDA has tried to alleviate the hardships caused to policyholders whose insurance policies cover treatment of hospitalization. In this blog, Secure Cover tries to explain what these guidelines are and how policyholders can avail coverage for treatment related to Covid-19. The main points of the instructions are as follows:

1. ‘Where hospitalization is covered in a product, insurers shall ensure that the cases related to Corona virus disease (Covid-19) shall be expeditiously handled’ – This means that all insurance providers whose policies cover cost of hospitalization must ensure that they settle claims pertaining to treatment for Covid-19 are settled quickly, efficiently and on priority basis.

2. ‘The cost of admissible medical expenses during the course of treatment including the treatment during quarantine period shall be settled in accordance to the applicable terms and conditions of the policy contract and the extant regulatory framework’ – This means that when in accordance with terms and conditions of the contract, policyholders can claim coverage not only for the expenses incurred for treatment of coronavirus in hospital, but also for those that are carried out when the patient is under quarantine.

3. ‘All claims reported under Covid-19 shall be thoroughly reviewed by the claims review committee before repudiating the claims’ – This means that insurance providers are barred from summarily rejecting the claims made with regard to treatment for Covid-19. The guideline empowers the review committee to decide on individual claims based on their merit.

4. ‘In order to provide need-based health insurance coverage, insurers are introducing products for various specific diseases including vector borne diseases. For the purpose of meeting the health insurance requirements of various sections, insurers are advised to design products covering the cost of treatment for Corona Virus’ – This advisory asks insurers to include, in future, coverage for Coronavirus (Covid-19) treatment in future when designing insurance products that include diseases including vector borne diseases such as flu or viral infection.

Through these instructions, IRDA hopes that all issues pertaining to claims settlement with regard to coronavirus infection will be competently handled and settled. These instructions came into effect immediately since the date of issuance of the circular i.e. 4th of March, 2020.

Disclaimer: The interpretation of the content of IDRA circular (Ref. No: IRDA/ HTL/ REG/ CIR/ 04/03/2020) is based on personal understanding and interpretation of the content of the circular by the writer. Readers are advised to go through the original circular and exercise their own discretion. Neither Secure Cover nor the writer of this blog will be held responsible for any wrongful understanding or interpretation of the content of this blog.

Readers can click on the following link to read IRDA’s Circular: https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo4057&flag=1