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"Examine Whether Claims Can Be Considered For Those Who Were Unable To Get Insurance Benefit For Not Getting Hospital Beds": Delhi HC Directs IRDAI

Nupur Thapliyal
27 May 2021 11:59 AM GMT
Examine Whether Claims Can Be Considered For Those Who Were Unable To Get Insurance Benefit For Not Getting Hospital Beds: Delhi HC Directs IRDAI
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The Delhi High Court on Thursday directed IRDAI (Insurance Regulatory and Development Authority of India) to examine as to whether the claims of people who were unable to get the benefits of insurance policies for not getting hospital beds can be considered owing to the "dearth of medical infrastructure" in wake of the second covid wave.A division bench comprising of Justice Vipin Sanghi...

The Delhi High Court on Thursday directed IRDAI (Insurance Regulatory and Development Authority of India) to examine as to whether the claims of people who were unable to get the benefits of insurance policies for not getting hospital beds can be considered owing to the "dearth of medical infrastructure" in wake of the second covid wave.

A division bench comprising of Justice Vipin Sanghi and Justice Jasmeet Singh also directed that any such consideration may take place by consultation between IRDAI and insurance companies.

Noting that the IRDAI has taken steps to mitigate the suffering of people at large on account of covid 19 pandemic, the Bench addressed couple of issues which must be considered by the IRDAI.

"It's a matter of common knowledge and we can take judicial notice at the same that for about 3-4 weeks when the current wave of pandemic was at its height, there was acute shortage of hospital beds not only in NCT of Delhi, but all over the country people suffering from covid 19 were not able to secure beds, much less icu beds and ICU beds with Ventilators. Thus, dozens of patients who required treatment took treatment at home." The Court observed.

Furthermore, taking note of the fact that various insurance policies issued by several insurance companies which have been in existence, do not cover claims unless the insured is hospitalized, the Court observed thus:

"Therefore, a large number of insured people won't be able to recieve any benefit under insurance policies held by them only because they couldn't get hospitalization with no fault of theirs and due to dearth of infrastructure."

In view of this, the Court ordered:

"IRDAI may examine as to whether claims in such cases could be considered by the insurance companies and the terms and conditions on which considerations may take place."

At this juncture, the Court further took note of the suggestion made during the course of hearing stating that the existing policy holders could be sent messages and given the option if they wish to get covered by the terms and conditions of the corona kawatch policy on payment of additional premium and that once the option is accepted, they should be covered by the terms and conditions of the corona kawatch policy and the additional premium charged. 

Noting this, the Court further observed:

"This could extend the reach of the policy to a large number of people who may not have availed the same. In our view, the aforesaid reasonable and valid concerns are listed before us and therefore we direct the IRDAI to examine these aspects and place a status report before us within four weeks."

The development came after the bench was apprised by the submissions made by Advocate Abhishek Nanda appearing for IRDIA and amicus curiae Rajshekhar Rao.

During the course of hearing, Amicus Curiae Rao suggested that IRDAI can verify claims of people who have denied claims only because they were denied beds within 24 hours.

In view of this, Mr. Amit Mahajan also suggested thus:

"I think everything is covered by the policy if the person is hospitalized. The problem is,what if he's not? With huge number of blood tests, a huge money was spent. Govt should consider covering them also. If the issue arises again, what then? Instead of issuing a new policy, why not previous policy is amended and new benefit is added into it?"

During the first half of the hearing, the Court directed that the Centre should consider complete waiver of import duties on amphotericin B drug, used to treat Black fungus, till the time it's shortly available in India. The bench also directed that the said imports shall be cleared by customs by accepting a bond from the importer without actual payment of import duty till the time a final decision on the aspect is taken.

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