IRDAI Chairman Ajay Seth has highlighted persistent gaps in health insurance claim settlements, urging insurers to ensure prompt, fair, and transparent claims processing. Despite over 3.26 crore health claims settled in FY25, the full amount settlement often lags, impacting policyholder trust and regulatory scrutiny.
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
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3.26 crore health claims settled in FY25, with ₹94,247 crore disbursed
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Chairman Seth calls for prompt, fair, transparent claim settlements
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Over 50% of insurance ombudsman complaints pertain to health claims
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Push for higher insurance penetration in rural and informal sectors
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Emphasis on digital access, innovative insurance products, and strong grievance redressal
Bima Bharosa platform resolves nearly 99% of policyholder complaints
Sources: Business Standard, Times of India, Moneycontrol, Economic Times