IRDAI's service clock for insurance is no longer guidance - it is a regulation. The Master Circular on Protection of Policyholders' Interests dated September 5 2024 plus the PPHI Regulations 2024 replaced the 2017 framework and cut turnaround times across the lifecycle, as mapped by Mondaq on October 29 2024 and summarised by ICICI Lombard's 2025 guideline review: insurer to decide a proposal within 7 days (down from 15), cashless authorisation within 1 hour, final discharge authorisation within 3 hours, and claim settlement or rejection within 30 days of the last necessary document (45 where a surveyor is appointed), with penal interest of 2% above bank rate for delay and a bar on rejecting a claim after an 8-year moratorium except for proven fraud. The 2026 TPA Health Services and Surveyors Amendments (CAalley) then amended who may run the clock.
Method: What This Guide Uses
Primary: Mondaq October 29 2024 "IRDAI's Update on Turnaround Times" mapping old versus new TATs under PPHI Regulations 2024 and the September 5 2024 Master Circular (pages 30-31 for cashless, 45-46 for retail general claims, R15 surveyor thresholds). Secondary: ICICI Lombard Health blog August 8 2025 and Niva Bupa April 23 2026 explainers on the same circular; IRDAI's 2026 circular list (CAalley) showing TPA and Surveyor amendments and the Ombudsman Self-Contained Note circular; BimaNiti status-of-claims FY24-25 data (99.93% SAHI within 3 months, 90.17-95.26% PSU) and the four exclusion lists. We treat the Master Circular as the operative TAT source and the 2026 amendments as the enforcement layer; where an insurer's policy wording conflicts, the regulation prevails, but Implementation timelines for legacy books are noted where relevant.
The Full TAT Table: What Changed, By How Much
Proposal stage: insurer must communicate acceptance within 7 days of receiving the proposal; if further details are needed, it must ask within that window, not reset it silently. Policy issuance: e-policy is default under the PPHI circular, with physical on demand. Endorsement/service requests: most require 7 days. Claim stage: health cashless authorisation 1 hour from hospital request, final discharge 3 hours after receipt of final bill; reimbursement and life claims 30 days from last necessary document; where a surveyor is mandatory (motor > Rs 50,000, other general > Rs 1 lakh) 45 days. Grievance redressal: 14 days with acknowledgement within 3 days, and the Ombudsman route requires a self-contained note now standardised per IRDAI's 2026 circular. The old regime's 30-45 day claim window remains, but the "ask for documents in instalments" tactic was curtailed: insurers must seek all required documents at once and justify any subsequent request as exceptional. Miss the window and the insurer pays penal interest at 2% above bank rate from due date to payment.
What Restarts the Clock - and What Does Not
The clock starts on receipt of the last necessary document, which is why the "all at once" rule matters. If you submit six of seven documents and the seventh only arrives on day 20, day 20 is day zero - a legitimate reason for the insurer, but one it must prove it requested upfront. Cashless is different: the 1-hour and 3-hour clocks start on receipt of the hospital's request, not your phone call, so insist the hospital logs the TPA submission timestamp and shares the acknowledgement; the PIR's future reference layer is designed to make that timestamp verifiable. The 8-year moratorium is the long clock: after 8 continuous years, no health claim may be contested for non-disclosure or misrepresentation except proven fraud, which interacts with portability (45-day notice via IIB) - carry forward waiting periods, no-claim bonus and the 60-month moratorium, but check the new policy does not silently add deductibles.
How to Use This When a Deadline Slips
Template one - delayed cashless: "Per Master Circular on Protection of Policyholders' Interests (Sep 5 2024), Part on cashless facility, TAT is 1 hour for authorisation and 3 hours for final discharge; request logged at [time], please confirm compliance or provide written reasons for delay." Template two - delayed settlement: "Per Regulation 15 of PPHI Regulations 2024, settlement or rejection is due within 30 days (45 with surveyor) from receipt of last necessary document on [date]; beyond that I am entitled to penal interest at 2% above bank rate." Attach the hospital/TPA acknowledgement and the last-document receipt. If rejected, demand the specific of the four exclusion lists: permanent exclusion, disease-specific waiting, sub-limit, or non-payable consumables; a rejection that says "exclusion" without naming which list fails IRDAI's disclosure norm. Escalate via the insurer's grievance cell, then the Insurance Ombudsman with the 2026-format self-contained note, then IRDAI's Bima Bharosa. Keep every timestamp - FY24-25 data shows the gap between 90.17% and 99.93% within 3 months is precisely a timestamp gap.