Partial settlement of claims by insurer, inflated hospital bills for Covid push woman to file plea in HC

The Delhi High Court has sought responses of the Delhi government and the IRDA on a plea by a woman and her two minor children challenging an insurance firm's decision not to pay the entire insured amount on her husband's death after contracting COVID-19, as reported by The Economic Times.
Delhi resident Sunita Goel and her two minor children said her husband held a mediclaim policy, Parivar Mediclaim Policy, of the insurance company and the sum insured was Rs 5 lakh. Her husband, Gulshan Kumar Goel, had to be hospitalised for Covid treatment on 30 June at Fortis Hospital, Shalimar Bagh. He expired on July 7, 2020.
The hospital raised a bill of Rs 5.33 lakh, which was paid by the woman as the insurance company committed a breach of policy terms and escaped from its liabilities of paying the hospital expenses to the extent of the sum insured, the plea claimed, adding that the hospital later refunded Rs 1.95 lakh on grounds that it was charged extra.
It added that later on, the insurer only reimbursed Rs 1.31 lakh to her on grounds that as per rates fixed by the Delhi government, the total bill amount should have been Rs 1.44 lakh.
Justice Rekha Palli issued a notice to the Delhi government, the Insurance Regulatory and Development Authority (IRDA), the National Insurance Company Ltd and Fortis Hospital at Shalimar Bagh, where the woman's husband died during treatment last year.
The court asked the authorities to file their replies within four weeks and listed the matter for further hearing on December 12.
The petitioners have also sought a compensation of Rs 25 lakh from the insurance company and the hospital.
The family has sought a direction to the insurance firm to reimburse the hospital bill amount, or as an alternative, the hospital be asked to return the money to her.
The plea further sought to direct the IRDA to take strict action against the insurance firm for violating its guidelines, framed for insurers to include the expense incurred on hospitalisation and treatment of COVID-19 patients, and to ensure its compliance so that no insurer may escape from their liability of making payment.
It also sought to direct the Delhi government to take strict legal action against the hospital for violating its June 2020 circular/guidelines which prescribed maximum per day package rates for treatment of COVID-19 patients in private hospitals here.
Further, the plea sought a direction to the government to ensure compliance of the circular within the territory of Delhi so that no private hospital may extort exorbitant charges for COVID-19 treatment.



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25th Sept 2020
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