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VADODARA: Did a third-party administrator (TPA) reject your insurance claim or deduct money from your claim amount under some or the other clause? Well, you may now hold the TPA responsible for going beyond its role and taking arbitrary action by rejecting your claim.
Recently, in at least half-a-dozen cases, the consumer court ruled in favour of the insured person just because the TPA had rejected their claim, citing the regulations of Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) Regulations, 2016
The Vadodara district consumer disputes redressal forum (additional) referred to regulation 3(2) of the rules which stated that ‘TPA shall not reject or repudiate any of the claims directly’ and ‘shall not directly make payments in respect of the claims.’