July 2020

Claims Settlement Claims under COVID-19 are required to be handled expeditiously and reviewed by the claims review committee of the Insurer before repudiation. Indemnity based health insurance products providing coverage for the hospitalization treatment costs (including the standalone “Arogya Sanjeevani Policy” health insurance product) are expressly required to cover the costs of hospitalization treatment incurred on account of COVID -19. With respect to unit linked policies maturing by 31 May 2020, where fund value is to be paid in lumpsum, Life Insurers have been permitted to offer settlement options in accordance with the erstwhile R25 of the IRDA (Linked Insurance Products) Regulations 2013, regardless of whether such option exists under the specific product. In terms of such settlement options, Life Insurers are also required to exercise all due diligence and clearly explain the possible risk of continued fluctuation of fund value based on daily NAV, and obtain the clear consent of the policyholder.

1. IRDAI has vide its circular dated March 4, 2020, instructed all insurers providing health insurance policies and covering costs of hospitalization to: review and expeditiously settle all claims with respect to costs of medical expenses incurred during treatment or during quarantine period as per the terms and conditions of the insurance policy; and devise policies to cover the costs of treatment of Covid-19 in order to meet health insurance requirements of various sections.

The Insurance Regulatory and Development Authority of India (hereinafter referred to as ‘IRDAI’) issued a circular on March 04, 20201(hereinafter referred to as ‘Circular’) for claims related to Corona virus. The IRDAI has directed all the health insurance companies to include medical cover for COVID-19 irrespective of the nature of policy held by the consumer.

Insurance sector plays a very vital role in stimulating the economy. It promotes financial stability, facilitates trade and commerce, manages and strengthens the risk-taking ability. IRDAI is responsible for monitoring the entire insurance sector in India and acts as the custodian for all insurance consumers’ rights. In light of the incessant spread of Covid-19 and prolonged lockdown in India, IRDAI has taken several steps by way of issuing circulars and press releases to provide guidance, clarification and relaxation to insurers and policyholders with the view to provide necessary support and protection in the present unprecedented circumstances.