IRDAI Monitoring Gaps in Health Insurance Claim Settlements: Chairman Ajay Seth

The Insurance Regulatory and Development Authority of India (IRDAI) is closely monitoring gaps in health insurance claim settlements. Chairman Ajay Seth emphasized that while the number of claims settled is substantial, the amounts settled—especially in full—are sometimes lower than expected, creating a trust deficit in the insurance sector. Speaking at BimaLokpal Day, Seth called for insurers to demonstrate fairness and transparency in claims handling, cautioning that anything less would weaken consumer confidence.

 

In FY25, general and health insurers settled 3.26 crore health insurance claims, disbursing ₹94,247 crore in claim settlements. Despite these high figures, complaints persist, with over half of insurance ombudsman grievances related to health policies. Seth urged insurers to expand insurance penetration, especially in underserved rural and informal sectors, to meet the national goal of “Insurance for All” by 2047.

 

The regulator is simultaneously pushing for enhanced digital access, innovative product design, and streamlined grievance redressal, noting a nearly 99% resolution rate of policyholder complaints through the Bima Bharosa platform. Bringing clarity and fairness to claim settlements remains a top priority for the authority.

 

Key Highlights:

 

IRDAI monitoring gaps where claim amounts paid are lower than claimed amounts

Bima Bharosa platform resolves nearly 99% of policyholder complaints

 

Sources: Business Standard, Times of India, Moneycontrol, Economic Times​