Mediclaim Insurance – Claim – IRDAI – Cap on treatment in AYUSH Hospital as compared full reimbursement for Allopathy treatment is unreasonable –
The Petitioner in two writ petitions had taken medical insurance policies in 2009 and at that time, it was not provided for any separate cap on AYUSH hospital treatment.
During Covid-19 Pandemic, the petitioners were affected by covid and they had taken treatment in Siddha Hospital (AYUSH Hospital).
The petitioners had claimed reimbursement. The Insurer had contended that the present policies governed by IRDAI regulations provide for cap on AYUSH hospital treatment. The policies of 2009 did not provided for expenses on treatment other than allopathy.
It was seen that the Insurer had brought AYUSH plan policy and brought said treatment on par with allopathic treatment.
HELD that the IRDAI must take into consideration the fact that patients can choose the type of required treatment and they have an option to opt for allopathy or traditional medicines of AYUSH. The expenses must be placed on equal scales. It will be discriminatory to give preference to allopathy against AYUSH treatment.
IRDAI is directed to act on the suggestion of the High Court.
Judgment dated 21.11.2023 in W.P.(MD) Nos.18130 and 18131 of 2021 of K. Krishna & M.C.Uma Maheswari Vs. The Managing Director, M/s. Star Health and Allied Insurance Company Ltd and others
