Discuss the regulatory provisions framed by IRDAI with special focus on "Protection of Policyholders interests" in respect of claims under life insurance.

The regulatory provisions framed by IRDAI with special focus on "Protection of Policyholders interests" in respect of life and general insurance claims is as under: The IRDA (Protection of policy holder Interest) Regulations, 2002, under clause 6 stipulates the matters to be included in a Life Insurance Policy Contract. As per Regulation 6 of Protection of Policyholders' Interests) Regulations, 2017, A Life insurance policy shall clearly state: the name of the plan governing the policy, its terms and conditions; whether it is participating in profits or not; the basis of participation in profits such as cash bonus, deferred bonus, simple or compound reversionary bonus; the benefits payable and the contingencies upon which these are payable and the other terms and conditions of the insurance contract; the details of the riders attaching to the main policy; the date of commencement of risk and the date of maturity or date(s) on which the benefits are payable; the premiums payable, periodicity of payment, grace period allowed for payment of the premium, the date the last instalment of premium, the implication of discontinuing the payment of an instalment(s) of premium and also the provisions of a guaranteed surrender value. the age at entry and whether the same has been admitted; the policy requirements for (a) conversion of the policy into paid-up policy, (b) surrender, (c) non forfeiture and (d) revival of lapsed policies; contingencies excluded from the scope of the cover, both in respect of the main policy and the riders; the provisions for nomination, assignment, and loans on security of the policy and a statement that the rate of interest payable on such loan amount shall be as prescribed by the insurer at the time of taking the loan; any special clauses or conditions, such as, first pregnancy clause, suicide clause etc.; and the address of the insurer to which all communications in respect of the policy shall be sent; the documents that are normally required to be submitted by a claimant in support of a claim under the policy. The Policy contract is approved by IRDAI. The IRDAI has advised that the language of the policy contract should be simple, unambiguous, clear and consistent for better understanding of common man. OTHER AREAS OF PROTECTION OF POLICYHOLDERS INTERESTS Claims under Life insurance policies: Upon death of the Life assured, the Nominee shall prefer a claim with the insurance company submitting certain claim documents. A life insurance company may investigate a claim to rule the possibility of any frauds, especially for early claims. Any claim occurring within 2 years of taking a Life insurance policy is categorised as 'Early claims'. This raises a suspicion of breach of the condition of 'utmost good faith', the obligation on the part of the Life assured to disclose the status of his/her health in the Proposal form correctly and without hiding any material information. Therefore, an investigation is undertaken by Life insurance companies with the probable Hospitals, Clinics, Diagnostic Centres, Treating Doctors etc., to verify the status of health of the Life assured at the time of taking the Policy. If the investigation reveal any adverse findings which were not disclosed in the Proposal form for Life insurance, the claim may be repudiated in terms of Section 45 of the Insurance Act, 1938. Following are the procedural compliance requirements under the IRDAI (Protection of Policyholders' Interests) Regulations, 2017: Customer requirements must be raised by Life insurance companies within 15 days of receipt of intimation. Non-investigation Claims shall be paid or rejected or repudiated within 30 days of receipt of receipt of all papers & clarifications. Time limit for completion of investigation – 90 days – claim to be decided within 30 days of receipt of investigation report. For delays in settlement of claims, interest @ 2% above bank rate shall be payable from the date of receipt of last necessary document. For disputes in title, payment can be made to Court (Section 47 of Insurance Act, 1938). Except claims under Section 47, where claim cannot be paid for want of identification of payee, interest at bank rate payable from the date when claim is ready for payment. Where nominee not traceable, claim cannot be written back. For deaths due to suicide, 80% of the premiums paid payable (for reinstated cases, higher of 80% or surrender value whichever is higher; for ULIPs fund value). Where fraud or misrepresentation is established, surrender value shall be paid. For maturity/survival benefit settlement to be made on or before due date. For delays interest at Bankrate+2% from due date or date of receipt of last necessary document from insured/claimant, whichever is later.