Health insurance claim rejection: Insurers may turn more cautious

Onus may now shift to them to justify rejection after Irdai's circular

The Insurance Regulatory and Development Authority of India (Irdai), through a circular dated March 19, 2021, has urged insurers not to repudiate health insurance claims based on ‘presumptions and conjecture’. It has also stated that any communication regarding claim repudiation must be sent by the insurer, and the message should cite the specific policy condition under which the claim is being denied.

Don’t reject based on assumptions

While evaluating claims, insurers do make inferences based on the evidence available to them, as these examples demonstrate.

Suppose a person is hospitalised for 24 hours. He is not offered any form of treatment but is