Insurers cannot reject claims based on presumptions and conjectures: Irdai

Insurers need to put in place systems by which policyholders can track the status of claims, says regulator

The insurance regulator on Friday said that general and health insurance companies cannot reject claims based on “presumptions and conjectures” and have to specify the reason for denial or rejection of claims by referring to the corresponding policy conditions. 

In a circular addressed to the insurers, the regulator said, “Claims shall be processed in a transparent, seamless and efficient manner within the prescribed timelines”. 

And, in the case of rejection or denial of a claim, the insurance company has to provide the policyholders with the grievance redressal procedures of the company as well as the insurance ombudsman, along with the