IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Kolkata
Award Ref: CIO/KOL/2024
Siliguri Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Siliguri, West Bengal • Ombudsman: Kolkata
Total Hospital Billed
₹250,000
Arbitrary TPA Cut
₹48,500
Legally Recoverable
₹48,500
Deterministic Math Comparison: TPA Cut vs. IRDAI May 2024 Statutory Math
| Line Item / Disputed Component | Billed (₹) | TPA Cut (₹) | Statutory Approved (₹) | Recoverable Overcharge (₹) | IRDAI Statutory Reference |
|---|---|---|---|---|---|
| Siliguri Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Siliguri OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Kolkata
Hindustan Bldg Annexe, C.R. Avenue, Kolkata
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Siliguri have the lowest reported cashless deduction variance?
Hospitals that adhere strictly to IRDAI May 2024 Clause 19 and refrain from levying unbundled administrative MRD fees achieve over 88% first-pass clean settlement in Siliguri.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Kolkata)
Address: Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, Kolkata - 700072
States & UTs Covered: West Bengal, Sikkim, Andaman & Nicobar