Care Health Insurance Under Scrutiny: InGovern Flags Regulatory Lapses Amid IRDAI Crackdown

Key Highlights

 

Proxy advisory firm InGovern Research Services has raised serious concerns over regulatory lapses at Care Health Insurance, a Religare Enterprises group company. This comes even as the Insurance Regulatory and Development Authority of India (IRDAI) intensified enforcement action against eight insurers, including Care Health, for serious lapses in health claim practices and regulatory compliance.

 

Nature of the Lapses

 

Govern's issues are centered on operational failures and deviations from IRDAI's Health Insurance Master Circular, which recommends strict requirements for claim settlement, cashless approvals, and customer disclosures.

 

Regulatory audits found problems including improper claim rejections, unjustified payment holdbacks, and payments lagging behind the stipulated time frames.

 

The offenses are said to involve failure to adequately comply with the master circular requirements for safeguarding the interests of policyholders and for transparency in the settlement of claims.

 

Regulatory Response and Industry Impact

 

After these revelations, IRDAI has started issuing show-cause notices to Care Health Insurance and seven other large insurers. The regulator is asking for detailed explanations and can impose corrective actions, including financial penalties or directions to refund sums (with interest) to harmed policyholders.

 

The review is amongst the most elaborate compliance checks in the industry this year, a testament to IRDAI's growing emphasis on business transparency and consumer protection.

 

Other insurers in the radar are HDFC Ergo, ManipalCigna, Star Health, ICICI Lombard, Niva Bupa, Tata AIG, and New India Assurance.

 

What's Next

 

The insurers will have to respond to the show-cause notices, after which enforcement action will be taken by IRDAI.

 

The episode serves to underscore the importance of sound administration, prompt payment of claims, and rigorous adherence to regulatory standards in India's rapidly expanding health insurance sector.

 

Sources: The Hindu Business Line, CNBC-TV18, Business Today