IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/TPA-CODE/TAT/2024
TPA Rejection Code TAT — >3-Hour Cashless Discharge Delay Holding Charge
Statutory Defense under Clause 6.1 of IRDAI Master Circular (May 29, 2024) • Legal Ground: Discharge SLA Violation
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 TAT | ₹80,000 | ₹32,000 | ₹80,000 | ₹32,000 | Clause 6.1 of IRDAI Master Circular (May 29, 2024) |
Verbatim IRDAI Circulars & Statutory Citations
Statutory Defense — Clause 6.1 of IRDAI Master Circular (May 29, 2024)
Insurers and TPAs must convey final discharge approval within 3.0 hours. If delayed, hospitals cannot collect extra room rent or holding fees from the policyholder.
Citation: IRDAI Master Circular dated May 29, 2024
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Is TPA deduction code TAT legally challengeable?
Yes. Insurers and TPAs must convey final discharge approval within 3.0 hours. If delayed, hospitals cannot collect extra room rent or holding fees from the policyholder. You can serve the ReclaimBill 2-Page statutory notice to overturn this deduction immediately.