IRDAI Reg Section 22 : Settlement of Claims

Explanation using Example

Example 1: Timely Settlement of Claims

Introduction: John, a policyholder with XYZ Insurance, files a claim for a car accident that occurred on January 10, 2024. The policy document clearly lists the required documents, such as the police report, repair estimates, and photographs of the damage.

Application: According to Section 22(1)(b) of the IRDAI Regulations, 2024, XYZ Insurance must settle John's claim within the turnaround time specified in their Board-approved policy. The policy states a maximum of 30 days for claim settlement.

Outcome: If XYZ Insurance fails to settle the claim within 30 days without a valid reason, they may face penalties for non-compliance with the IRDAI Regulations. This could include fines or other sanctions as per the regulatory framework.

Conclusion: Compliance with the timely settlement requirement ensures that policyholders like John receive prompt service, maintaining trust in the insurance process.

Example 2: Documentation and Communication

Introduction: Sarah purchases a health insurance policy from ABC Insurance. The policy document includes a list of documents required for claim settlement, such as hospital discharge summaries, medical bills, and prescriptions.

Application: As per Section 22(1)(a) of the IRDAI Regulations, 2024, ABC Insurance must ensure that this information is prominently displayed on their website and clearly communicated to Sarah at the time of policy issuance...

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