FPJ Legal | Plea filed in Bombay HC seeking directions against private hospitals, insurance companies who harass COVID-19 patients

Mumbai: Alleging harassment of Covid-19 patients at the hands of private hospitals and insurance companies, an application has been filed in the Bombay high court seeking investigation into alleged rejection of policyholders’ claims by insurance companies in an arbitrary manner.

The intervention application has been filed by advocate Rajesh Inamdar before the Bombay high court which is hearing a public interest litigation of Nilesh Navlakha seeking relief for Covid-19 patients.

Inamdar has also sought that the insurance companies be directed to process cashless facilities for Covid patients.

Inamdar filed the application highlighting the hardship faced by him during his and his family members’ hospitalization after being diagnosed with Covid-19. His application has sought that action should be initiated against private hospitals and insurance companies for “arbitrary rejection/repudiation of the claims of the policyholders in completely arbitrary, frivolous, mechanical and mischievous manner” as it is “prejudicial to the interest of the policyholders and the public at large”.

His application prays that the high court direct the Insurance Regulatory and Development Authority of India (IRDA) to conduct an investigation under the Insurance Act and direct the insurance companies to immediately reimburse all claims of the patients which were “arbitrarily and mischievously rejected”.

“The court should ask IRDA to investigate and file a report as to how many claims were rejected by insurance companies in an arbitrary, frivolous, mechanical and mischievous manner and denied benefits of insurance policy to the policyholders and have taken undue advantage of the pandemic to unjustly enrich themselves,” prays the application.

Inamdar has also prayed that directions be issued to the Pune Municipal Corporation (PMC) to conduct an audit into affairs of all the hospitals and investigate if there is a systematic fraud played by hospitals in connivance with insurance companies to exploit and unjustly enrich themselves by denying the benefits of insurance claims to the policy holders.

The application states that recently PMC had conducted an audit of hospital bills of Covid-19 patients it (PMC) has reduced a total of Rs 5.03 crore bill of 1,536 patients. In the first week of July, a bill amount of Rs 17.21 lakh was reduced for 188 patients who got treated at private hospitals in the city.

The insurance companies have been arbitrarily rejecting insurance claims , citing unnecessary hospital stays. The companies have been adopting a completely mischievous, unethical and inhumane approach while considering the request for cashless facility of Covid patients over hospital stay by furnishing super-medical advice, over and above the advice rendered by the medical experts, on the necessity of hospitalisation of patients,” he said.

Inamdar has stated that it is doctor’s sole discretion to place a patient in either home quarantine or advice hospitalisation based on previous medical history and co-morbidities of a Covid-19 patient. “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 application further alleges that despite instructions from IRDA, the Insurance companies have been denying cashless facilities to patients. The process of reimbursement has also become a terrible and tiresome affair, wherein medical refund is available after unfair and unreasonable deductions, which went up to 40% to 50% of the actual bill amount.

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