IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/TPA-CODE/C10/2024
TPA Rejection Code C10 — Essential Surgical Consumables & PPE Disallowed
Statutory Defense under IRDAI Health Insurance Regulations Annexure-1 • Legal Ground: Consumables Rejection
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 |
|---|---|---|---|---|---|
| Disputed line items under Code C10 | ₹80,000 | ₹32,000 | ₹80,000 | ₹32,000 | IRDAI Health Insurance Regulations Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
Statutory Defense — IRDAI Health Insurance Regulations Annexure-1
Essential operative supplies like sutures, gloves, cannulas, and drapes are integral to clinical treatment and cannot be arbitrarily rejected.
Citation: IRDAI Master Circular dated May 29, 2024
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Is TPA deduction code C10 legally challengeable?
Yes. Essential operative supplies like sutures, gloves, cannulas, and drapes are integral to clinical treatment and cannot be arbitrarily rejected. You can serve the ReclaimBill 2-Page statutory notice to overturn this deduction immediately.