Delhi HC issues notice in plea against capping of Covid claims by insurance company

The Delhi High Court on Monday issued notice in a plea praying for issuance of directions to National Insurance Company Ltd. for wrongful capping of reimbursement amount for Covid-related claims.

Justice Rekha Palli observed that National Insurance Company Ltd. has capped the reimbursement amount for the petitioner who had the “Parivar Mediclaim Policy” which is a “cashless policy”.

The petitioner along with her family was covered under “Parivar Mediclaim Policy”. On June 20, 2020 Government of National Capital Territory of Delhi, Health and Family Welfare Department issued an order by which it fixed the rates for Covid-related treatment to be charged by private hospitals.

In the first week of September i.e on 5.09.2020 the petitioner and her daughter tested positive for Covid-19. Total bill raised by the hospital for petitioner’s hospitalization for a period of five days was Rs. 118,479.20 however the insurance company had cleared only Rs.54,954. The petitioner had to pay Rs. 63,525 in order to get discharged from the hospital.

Later the petitioner was informed that the “Old Parivar Mediclaim Policy” had been abolished since 12.08.2020 and all the “Parivar” clients have been migrated to other policies.

It was asked by the petitioner that without their prior knowledge and consent how could the insurance company migrate them to a different policy.

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Later, the petitioner received a mail from branch manager of National Insurance Company, M. Chandrasekaran asking for a scanned copy of cancelled cheque to enable to settle the balance claim amount of Rs.15, 985. The petitioner told Chandrasekaran that the claim amount is Rs.63,525, and also asked for an additional compensation of Rs 5 lakh for mental harassment.
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