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84% Covid claims got settled; average payout per claim is Rs 96k

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The non-life insurance industry has settled about 84 percent of the Covid-19 claims lodged to date with the average payout per claim being about Rs 96,000.

A senior industry official preferring anonymity told IANS that the industry received a total of about 11.05 lakh Covid-19 claims amounting to about Rs 15,570 crore since the pandemic broke out in India last year.

It is learnt the average amount per claim is about Rs 1,40,085, while the average payout per claim is Rs 95,777.

The total payout made by the non-life insurers towards Covid-19 claims is about Rs 8,900 crore.

Citing the Insurance Regulatory and Development Authority of India’s (IRDAI) direction to insures to authorise cashless treatment within an hour of receiving the request with necessary papers from the hospital, the official said it is going to be a tall order to meet.

Further the insurers/Third Party Administrators (TPA)-the claim processing agencies-have to communicate their decisions on the final payout within one hour of receipt of the final bill from the hospital.

Firstly, the officials of Third Party Administrators (TPA) are also working from homes managing handicaps like fast net connectivity, power cuts, and many of them are also affected by Covid-19, the official said.

On the issue of coming out with a package rates for treating Covid-19 patients, the official pointed out that the General Insurance Council last year published a schedule of rates for Covid-19 claims after discussions with medical professionals employed by member insurance companies.

The General Insurance Council had said insurers shall be guided by the treatment protocols prescribed by the Indian Council of Medical Research.

The Council said the rates are broadly based on the schedule of rates suggested for Covid-19 treatment by a Niti Ayog panel.

Further state governments also ordered a cap on treatment costs last year.

Now the Covid-19 cases have increased manifold and there is an acute shortage of beds. So the priority will be on getting admitted at any cost and not haggling about treatment costs, the official said.

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