IRDAI pulls up 8 top insurers over health portfolio lapses, may take coercive action — Report
The Insurance Regulatory and Development Authority of India has started the process to issue show cause notices to as many as eight insurance companies after allegedly finding lapses in their health insurance portfolios, a report said.
As per the report by CNBC TV18 on Friday citing sources, the eight companies that were are being sent show cause notices by the IRDAI include — Niva Bupa Health Insurance, Star Health & Allied Insurance, Care Health Insurance, ManipalCigna Health Insurance, along with New India Assurance, Tata AIG General Insurance, ICICI Lombard General Insurance, and HDFC ERGO General Insurance.
Livemint could not independently verify the authenticity of the report. This article will be updated if IRDAI releases a statement.
What did the IRDAI say?
According to the report, IRDAI flagged multiple violations committed by the insurers with regard to the implementation of its Health Insurance Master Circular, issued in May 2024.
The circular outlines strict norms for claim settlement time, cashless approvals, and customer information disclosures.
Other violations include — unnecessary deductions from payouts of claims, improper rejection of claims and delayed claim settlement exceeding prescribed timeline.
The IRDAI had last month found major lapses in health insurance claim processes of these insurers after it conducted inspections, the CNBC TV18 report says.
IRDAI may take action
In its board meeting next week, the IRDAI is reportedly going to formally discuss issuing the show cause notices to the companies.
If the insurers remain non-compliant following the evaluation of their responses, the regulatory body may take coercive actions, including financial penalties or directions to refund amounts (with interest) to affected policyholders, according to the report.
The IRDAI’s plan comes simultaneously with the Centre’s plans to bring its existing health insurance claims portal under the finance ministry and insurance regulator to curb overcharging by healthcare providers, which was reported by Reuters earlier.
Responses
New India Assurance and ICICI Lombard have acknowledged the action by IRDAI, saying that these were part of routine regulatory supervision to strengthen compliance of operations. They also emphasised that they had taken up all necessary corrective measures, including simplifying overly detailed Customer Information Sheets and reinforcing Claims Review Committee membership rules.
Other insurers have not yet issued a response.
