New Delhi: Insurance regulator Irdai has asked the general and health insurance providers not to deny claims against 'antibody cocktail therapy' to COVID patients and devise a mechanism to clear such dues as per the norms.
The insurers are denying such claims on the pretext that these are experimental treatments.
"Authority has come across instances of denial of claims and/or deduction of expenses incurred towards 'Antibody Cocktail therapy' treatment for Covid-19, under the pretext that the said therapy is an experimental treatment," the Insurance Regulatory and Development Authority of India (Irdai) said in a circular issued to the CMD/CEOs of general and health insurers.
Irdai said the antibody Cocktail (Casirivimab and Imdevimab) has been given emergency use authorisation (EUA) in May 2021 by the Central Drugs Standard Control Organisation in the country.
"In light of the above, insurers are advised to review the claims denied/deductions made in such claims and take appropriate action for ensuring that the claims are settled as per terms and conditions of the policy," according to the Irdai circular dated January 7, 2022.
The regulator has also asked the insurers to put in place effective claim settlement procedures to update the developments/approvals given by relevant authorities so that all claims are settled as per the terms and conditions.
Insurance broking firm SecureNow said the circular assumes significance as many of such treatments were legitimate treatments and rejection of claims is a big issue.
There is considerable uncertainty on treatment protocols in the third wave, Kapil Mehta, co-founder, SecureNow,
said.