Snehal Upadhyay-
An interim application has been filed in the High Court of Bombay by advocate Rajesh Inamdar, highlighting the problems faced by COVID-19 patients having an insurance policy for settling bills of a private hospital.
The advocate pleaded to Court to order the Insurance Regulatory and Development Authority of India (IRDA) for investigating in accordance with the Insurance Act and direct the insurance companies to immediately reimburse all claims of the patients which were “arbitrarily and mischievously rejected”.
The applicant requested the Court to order the Pune Municipal Corporation (PMC) to do an inspection of all the private hospitals and to investigate the fraudulent activities of the private hospital if any in connivance with insurance companies to exploit and unjustly enrich themselves by denying the benefits of insurance claims to the policyholders.
It’s the doctors who have the authority to suggest any COVID-19 patient for getting in-home quarantine or hospitalization “However, the claims are unilaterally and mischievously rejected by the insurance companies stating that the patient did not need to go to the hospital, in a brazen display of high-handedness and apathy,” the application read.
The applicant complained that even after getting the instructions from IRDA the insurance companies have failed and have been refusing cashless facilities to the patients. The reimbursement process has also been troublesome, as the medical refund is available after unfair and unreasonable deductions, which gets up to 40% to 50% of the actual bill amount.
“Any medical opinion by the insurance companies to deny the claims contrary to the opinion of the doctors or the hospitals suggesting hospitalization is entirely untenable, illegal and in denial of the claim of the policyholders amounts to profiteering, extortion and unjust enrichment,” the advocate said.
The Court will further hear the case after three weeks.