IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/TPA-CODE/R02/2024
TPA Rejection Code R02 — Room Rent Proportionate Deduction Scaling
Statutory Defense under Clause 19 of IRDAI Master Circular 2024 • Legal Ground: Proportionate Deduction
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 R02 | ₹80,000 | ₹32,000 | ₹80,000 | ₹32,000 | Clause 19 of IRDAI Master Circular 2024 |
Verbatim IRDAI Circulars & Statutory Citations
Statutory Defense — Clause 19 of IRDAI Master Circular 2024
IRDAI Circular strictly bars room rent proportionate scaling on fixed MRP medical devices, implants, medicines, and ICU charges.
Citation: IRDAI Master Circular dated May 29, 2024
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Is TPA deduction code R02 legally challengeable?
Yes. IRDAI Circular strictly bars room rent proportionate scaling on fixed MRP medical devices, implants, medicines, and ICU charges. You can serve the ReclaimBill 2-Page statutory notice to overturn this deduction immediately.