The Madras High Court recently observed that each and every step in the treatment of Covid-19 during the pandemic years, especially 2020, should be considered critical care for the purpose of medical insurance payment or reimbursement of the medical bill.
The bench of Justice Battu Devanand said, “Covid-19 symptoms range from asymptomatic to deadly… As such, to classify the medical assistance provided into critical or non-critical categories would be a farce, as in 2020 the whole pandemic situation was burning the country… Thus, each and every step in the treatment should be considered critical.”
The court held that anyone deprived of such medical care or insurance or reimbursement is directly being deprived of their Right to Life under Article 21 of the Constitution. It also made observations, while passing orders in a writ petition filed by a retired secondary school teacher.
The petitioner was infected with Covid-19 in 2020. At the time, she was 73 years old with Type-II diabetes and had also undergone a corollary artery bypass grafting (CAVG) open heart surgery in 2016. Though the petitioner was a beneficiary and insured under the New Health Insurance Scheme (NHIS) for employees and pensioners formulated by the finance (pension) department. She was paying Rs 350 per month as premium, but the United India Insurance Company Ltd held her not entitled to a reimbursement of Rs 2,62,596 incurred for Covid treatment on the ground that it was non-critical care in a non-network hospital.
The court further observed that the ground taken by the insurance company was “inhuman, irrational, unreasonable, unjust and violative of the right to life guaranteed under Article 21 of the Constitution of India”. It said United India Insurance Company Ltd should have considered the petitioner’s claim with reasonably and with utmost care.
“It is not fair for the respondent no 4 (United India Insurance Company Ltd) to include such clauses and impose such conditions in the terms and conditions of the policy/scheme, which are against the public interest,” the court said.
“…during the pandemic period, as there was a great demand for admission to hospitals for Covid-19, the public, including government employees and pensioners, were left with no other option but to take treatment in private hospitals not covered under the network hospitals listed under the different health insurance schemes,” the court added.
In view of the directions on June 6, 2022, issued by the state government to clear claims of eligible expenses incurred by government employees (present and retired) under non-critical Covid care undertaken in a non-network hospital, the court directed the petitioner to resubmit her claim.
Further, the court directed the United India Insurance Company Ltd to settle the accounts within the given time frame. Taking into account the age and health conditions of the petitioner, for the inconvenience and hardship being suffered by her, the court also directed the respondents to pay her Rs 25,000 as compensation.
Comments
0 comment