Claim stuck and not settled yet?
Weeks of “under process” is frustrating, especially after paying the hospital yourself. IRDAI has set a deadline for reimbursement claims, and interest is due if the insurer misses it.
The deadline
- Reimbursement (non-cashless) claims must be settled within 15 days of the claim being submitted.
- Some older policy wordings say 30 days after the last document, or 45 days if investigated. Those come from rules IRDAI has since replaced. The 15-day rule is the current standard.
- Insurers must publish their turnaround times for pre-authorisation, final bills and reimbursement on their website and in the customer information sheet.
Interest if the insurer is late
If the claim isn’t settled in time, the insurer must pay interest at the bank rate plus 2% a year, from the date it received the claim intimation to the date of payment. It has to pay this on its own, without you asking. If the matter reaches the Insurance Ombudsman, the award carries interest from the date the claim ought to have been settled.
What to do
- Note the date you submitted the claim and keep the acknowledgement.
- After 15 days, write to the insurer asking for the decision and the interest due.
- If there’s no answer, complain to the Grievance Redressal Officer and register it on Bima Bharosa.
- If the insurer doesn’t resolve it within a month of your complaint, delay in settling a claim is a ground for an Insurance Ombudsman complaint.
Questions people ask
How many days does an insurer have to settle a reimbursement claim?
15 days from submission of the claim, under IRDAI’s Master Circular on Protection of Policyholders’ Interests (2024).
What interest is due on a late claim?
Bank rate plus 2% a year, payable by the insurer without being asked. The bank rate is set by the RBI, so check the current figure.