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...TPA ID cards of the complainant and her husband. Ex A2 is the Health Insurance Policy. Ex A3 is the Claim Settlement Letter. Ex A4 is the final bills issued by the Hospital. Ex A5 is the IRDA Circular of 2013. Ex A6...of Claim settlement letter dated: 14.04.2018 Ex A4 Copy of Final Bills of Dr. Harikishan Eye Care Ex A5 Copy of IRDA Circular 2013
Ex A6 Copy of MOU Format Hospital and TPA dt 04.01.2017 Ex...although the same were against the terms and conditions of the IBA Group Health Insurance Policy of the Complainant and IRDA Regulations 2013
(F.NO. IRDA/Reg/14/72/2013...
...requested the respondent to release the amount in terms of IRDA circular dated 07 June, 2016. It is further submitted that the petitioner issued the invocation notice dated 02 December, 2020. The legible...
...circular of 2016. Ex A7 is the IRDA circular of 2013. Ex A8 is the MOU executed between Opposite Party No. 3 and Opposite Party No. 4 including GIPSA network declaration form. Ex A9 is the claim settlement...information Mr. N. Hema Rao issued from Paramount Health Service TPA dt. 16.12.2017 & 27.12.2017.
Ex.A6 - Copy of
IRDA Circular (IRDA/HLT/REG/CIR/146/07/...- Copy of
IRDA Circular (F.No.IRDA/14/72/2013 dt.16.02.2013.
Ex.A8 - Copy of
MOU format...
.../06/2016 dated 07.6.2016. The aforesaid circular, to the extent it is relevant, reads as under:
"This refers to the circular No. IRDA/NL/Cir/Misc./173/09/2015 dated....
5. The learned counsel for the complainant relied upon a Circular dated 24.9.2015, issued by Insurance Regulatory & Development Authority of India (IRDA) in support of her contention that mere...execution of the Discharge voucher would not entitle the insurer to deny a claim, which is otherwise genuine. The said Circular dated 24.9.2015, was followed by another Circular No. IRDA/NL/CIR/MISC/113...
....
a. The first circular of IRDA regarding Genetic disorder was issued th on 29 July 2016, Ref no. IRDA/HLT/REG/CIR/150/07/2019 th dated 29 July, 2016. In which the Ins...summary and hospital registration certificate and letter of complainant with the IRDA circular to the opponent.
6. On admitting the complaint for consideration, notice...the complainant. The complainant has also produced the IRDA circular which says that Genetic Disorder should not be put in the exclusion clause of the policy. The circular is at Ex. 4/7 of the...
.... RDA/HLTH./MISC/CIR/216/09/2011. The Forum held that reasons for delay were genuine. The Forum held that this was a fit case in which the OPs should have allowed the case as stated in the IRDA Circular. The Complaint has been partl... 15. The further Circular dated 28/10/2016, issued by IRDA says that the Circular IRDA/HLTH/MISC/CIR/216/09/ 2011 dated 20/09/2011, in the matter of dealing with claims where...), decided on 11/01/2016. In both the cases above and in connected matters, the said IRDA Circular was not considered and the repudiation of the claim was prior to the coming into force of the said IRDA...
.... It was stated that the claim under the critical illness could not be paid as the terms critical illness was well defined under the policy terms and conditions in concurrence with IRDA circular, Ref: IRDA/HLT/REG/CIR/146/07/2016. The...
...April, 2016, wherein the following has been held:
10. So far as IRDA circular referred to by the State Commission in the impugned order is...after 21 days of theft and due to this delay, even the survey could not be conducted. Based on this delay, the claim was repudiated. The learned counsel stated that the IRDA Circular dated 20.9.2011...vehicle occurred within the currency of the policy in question. The relevant portion of the IRDA Circular No. IRDA/HLTH/MISC/CIR/216/09/2011 reads as under:
"The...
...IRDA circular dated 24.09.2015 was not in accordance with the IRDA Regulation 2002 and thus, is no longer valid and thus, could not be relied upon in view of the circular dated 07.06.2016. For the sake...of brevity, the operative part of the fresh circular of IRDA dated 07.06.2016 has been reproduced below:
"…..
i...Petition No. 495/2015 filed by the present Respondent under Section 11of the Arbitration and Conciliation Act, had taken note of the circular dated 24.09.2015 issued by the IRDA, which was reflected in the...
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...Others Vs. Rahul Kadian reported in 2018(3CLT)(1), Hon'ble National commission was pleased to consider IRDA circular No. IRDA/ HLTH/ Misc/ CIR/ 2016/ 09/ 2011 dated September 20, 2011. That circular...tune of 15 lakhs has come into force by dint of a judgment of Hon'ble Supreme Court in IRDA based regulation with effect from 1st September, 2018. Therefore, it is evident that in the case at hand the...
...Pvt.Ltd., IRDA circular Ex.A7 is Circular (IRDA/HLT/REG/CIR/146/07/2016) Dt.29.07.2016 Ex.A8 is Renewal of Group Health insurance policy for retires (Ref.no.UIIC/IBA CELL/BDP/002.../2018), Dt.12.7.2018 Ex.A9 is IRDA Circular (F.No.IRDA/14/72/2013), Dt.16.2.2013 Ex.A10 is MOU format of Dr.Harikishan Eye Care hospital and Mid Assistant TPA including GIPSA network...
...consent letter either for settlement on repair basis or for cash loss basis settlement. In the light of the CIRCULAR O.M.P. (COMM) 345/2017 Page 9 Ref-IRDA/NL/CIR/MISC/113/06/2016 Date: 07.06.2016 it is...continuously requesting for the acceptance of offer made by them in spite of disbursing the claim as per the direction given in CIRCULAR O.M.P. (COMM) 345/2017 Page 9 Ref-IRDA/NL/CIR/MISC/113/06/2016 Date...Supplied) It is seen that vide subsequent Circular dated 07.06.2016 IRDA permitting the continuance of the practice of obtaining discharge voucher if only instructed by the insurers not to obtain such...
...Eye Care Hospital dt. 20-12-16. Ex.A16- Copy of First consultation letter Dr. Harikishan Eye Care Hospital from IRDA, dated 09-12-2016. Ex.A17- Copy of Circular from IRDA dated29-07-2016. Exhibits...-12-2016. The said hospital estimated surgery the cost at Rs, 65,800/- (Rupees Sixty Five Thousand Eight Hundred Only). OP3 approved an amount of Rs. 40,000/- (Rupees Forty Thousand Only) under cashless...opposite parties have not denied the nature of treatment obtained by the complainant from Dr. Harikishan Eye Care Hospital on 09-12-2016. The total bill amount raised by the said hospital was for Rs. 65,800...
...Chairman"
14. The further Circular dated 28/10/2016, issued by IRDA says that the Circular
"IRDA/HLTH/MISC/CIR/216/09/ 2011" dated 20/09....
13. The Insurance Regulatory and Development Authority (IRDA), issued a circular. The IRDA Circular No. RDA/ HLTH./MISC/CIR/216/09/2011 reads as under:
...Circular "IRDA/HLTH/MISC/CIR/216/09/2011" dated 20/09/2011, are bound to be followed by all the non-life insurers."
15. In view of the above circular, we cannot appreciate...
....
a. The first circular of IRDA regarding Genetic disorder was issued on 29thJuly 2016, Ref no. IRDA/HLT/REG/CIR/150/07/2019
dated...29thJuly, 2016. In which the Insurance companies were directed not to put the Genetic disorder in the exclusion clause. The complainant has placed the circular at 4/7 in which, it is mentioned in... of Guidelines on Product Filing in Health Insurance Business (Ref. No: IRDA/HLT/REG /CIR/150/07/2016 dated 29th July, 2016)." c. On 19thMarch 2018, in pursuance of the above...
...Company Ltd. v. Rajnish Gupta). Learned Senior Advocate for the petitioners relies upon a Circular dated March 31, 2016 issued by the Insurance Regulatory and Development Authority of India and...circulars of the Insurance Regulatory and Development Authority of India (IRDA) are relevant to the first issue. The first is a Circular dated November 23, 2010. It refers to an order passed by the Delhi..., therefore, bound unconditionally to honour such award. The circular requests the insurers to review the cases filed in light of such decision. The next circular is dated November 3, 2015. IRDA notes...
...नाहीत. मात्र, तक्रारदाराांनी दवमा कां पनीच् या पत्रानुसार कागदपत्राांची पुतकता क ली नाही, त यामुळ तक्रारदाराांचा क् ल म नामांजूर क ला असता बचाव घ तला आह . याबाबत आ ही IRDA Circular, Ref :
.../2011, Date.20/09/2011आदण IRDA
Circular, Ref : IRDA/NL/CIR/MISC/149/06/2017, 28thJune, 2017 मधील तरतुदी दवचारात घ...
...one and submitted that the effect of the IRDA circular of 2016 has not given but the procedure must be fair, just and reasonable. On one hand when the complainant was covered by the policy dt.12/05/2016...reasonable procedure which is a part and parcel of procedure establish by law under our Constitution. It is submitted that though, IRDA circular dt.29/07/2016 at page no.340 has no retrospective effect but...the Probability" which is axiomatic in Civil Law. It is also submitted that IRDA circular dt.10/04/2019 also requires to be applied in the present case because the complainant suffered heart attack in January 2019. It is also remind...
...paid by the complainant to the hospital and got discharged. It is submitted that, as per IRDA Circular dated:29.07.2016 (Ref: IRDA/HLT/REG/CIR/146/07/2016) guidelines on standardization of Health...: 14.07.2020. Ex.A8 - is the Xerox copy of Insurance Regulatory And Development Authority Notification, dated: 16.02.2013.
Ex.A9 - is the Xerox copy of Circular IRDA...six hundred and sixty one only) along with interest rate of 12% per
2
annum and additional 2% as per IRDA...