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CMA Final · Risk Management in Banking and Insurance · Concept and Types of Health Insurance Policies

A standalone health insurer, Arogya Care Ltd, is rejecting a claim made on 12 March by Mr. Rao. Under Section 14 of the Insurance Act, 1938, which entry must the insurer's record of claims contain for this rejected claim?

The record must show the claim date, the claimant's name and address, and, since the claim is rejected, the date of rejection and the grounds of rejection. Section 14(1)(b) requires all of these, so recording only the rejection date or policy details is insufficient.

  1. AOnly the policy number and the premium paid
  2. BThe claim date, claimant's name and address, and the date of rejection with the groundsCorrect
  3. COnly the date of rejection, without grounds
  4. DThe name of the surveyor and the hospital's bill details

Explanation

Section 14(1)(b) requires a record of every claim with its date, the claimant's name and address, and, for a rejected claim, the date of rejection and the grounds. Omitting grounds, as in the third option, is incomplete.

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