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Insurance Claim Processing Procedures

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Questions and Answers

What is the consequence for an insurer if they delay settling a claim?

They have to pay interest at a rate of 2% above the bank rate from the document receipt date until the claim payment date (correct)

They must update the Unique Transaction Reference (UTR) Number

They must upload the repudiation letter onto the NCIP portal

They need to establish real-time integration with the SARTHI portal/AIDE App

What is the responsibility of Insurance Companies (ICs) for repudiated claims?

Update the Unique Transaction Reference (UTR) Number

Establish real-time integration with the SARTHI portal/AIDE App

Upload the repudiation letter onto the NCIP portal (correct)

Process refunds within 15 days of receiving the cancellation request

What action should Insurance Companies (ICs) take for approved claims?

Process refunds within 15 days of receiving the cancellation request

Upload the repudiation letter onto the NCIP portal

Update the Unique Transaction Reference (UTR) Number (correct)

Establish real-time integration with the SARTHI portal/AIDE App

What is the purpose of establishing real-time integration with the SARTHI portal/AIDE App?

To enable access to a claims dashboard displaying claim statuses Signup and view all the answers

What is the purpose of the distinctive claim reference number (URN) assigned to each lodged claim?

To track the progress of the claim processing Signup and view all the answers

In what circumstances does the Insurance Company (IC) communicate with the policyholder/claimant through a Registered letter and via telephone?

When additional requirements need to be fulfilled Signup and view all the answers

What action must the Insurance Company (IC) take if any grievances are raised to the Ministry/SARTHI team by the policyholder/claimant?

Substantiate the need for clarification Signup and view all the answers

When does a claim advance to the subsequent stages of assessment and processing as per the text?

Once additional requirements are fulfilled Signup and view all the answers

What is the next step after the claim processing outcome results in approval?

Disbursing the claim amount to the claimant's Aadhaar-linked bank account Signup and view all the answers

What is required if a claimant raises a grievance regarding a repudiated claim to the Ministry/SARTHI team?

Presentation of relevant and substantial evidence supporting the repudiation decision's rationale Signup and view all the answers

Under what circumstance will a claim be closed without payment?

Solely due to non-submission of documents Signup and view all the answers

What is the purpose of providing an official claim repudiation letter with a detailed explanation for rejection?

To inform the insured policyholder/claimant about the rejection reasons Signup and view all the answers