Your Health Claim Is Delayed. The Clock Is Already Running.

Most health claim delays are not the insurer's fault on paper. They are the result of repeated document queries, partial responses, and unclear escalation paths. The 2024 IRDAI Master Circular cuts through it twice. First: 'No claim shall be rejected or closed for want of documents or for delayed intimation of claim.' Second, and this is the one insurers rely on you not knowing — if the claim is not settled within the specified timeline, interest at bank rate plus 2% runs from the date the insurer was first intimated of the claim — and the insurer must pay it automatically, without you asking.

The trick insurers rely on is making you believe the clock restarts with every query. It does not. The Master Circular anchors your interest to the date the insurer RECEIVED YOUR INTIMATION — not to the day the file was finally judged complete. Each follow-up query resets the perception of the timeline, not the entitlement. Note the date you first intimated the claim and count from there.

The right move is to break the loop. Submit every document in a single indexed bundle with a covering letter that lists each item. Ask the insurer for a consolidated query list, not piecemeal questions. If queries keep coming, escalate to the Grievance Redressal Officer with a TAT-violation citation.

BimaHaq drafts the TAT-violation letter, pins the insurer to a written acknowledgement of your intimation date — the date the interest runs from — and pursues that interest where it is due. We also know which TPAs and insurers respond best to which tone — and which need an Ombudsman escalation to wake up.

Pursuing delay is not always glamorous. But it works. We have recovered settlements ranging from ₹40,000 to ₹14 lakh purely on TAT grounds, with interest, after the policyholder had given up.