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Friday, July 30, 2021

Lawyer files plea in HC over insurance firms rejecting claims of Covid patients, seeks audit of private hospitals

“The insurance companies have been rejecting the claim of the Covid patients all over the state, citing “unnecessary” hospital stay on completely arbitrary and frivolous grounds,” he claimed.

Written by Ajay Jadhav | Pune |
Updated: July 17, 2021 8:51:44 am
Plea highlighting ‘illegal, unauthorised’ structures in Kalyan-Dombivali quite serious, says courtSeeking responses from the authorities, HC posted a further hearing on the PIL to July 29. (File photo)

CITING HARASSMENT and agony of Covid-19 patients, caused by private hospitals and insurance companies over the settling of hospital bills, a lawyer, Rajesh Inamdar, has filed an interim application in the Bombay High Court seeking an investigation into the rejection of policyholders’ claims by insurance companies in an arbitrary manner and directing the insurance companies to process cashless facility of the Covid-19 patients.

In an ongoing Covid-related case, filed by Nilesh Navlakha, Inamdar has filed an interim application based on his personal experience to highlight the problems faced by patients with an insurance policy in settling hospital bills in private hospitals, and rejection of claims by the insurance companies.

“The insurance companies have been rejecting the claim of the Covid patients all over the state, citing “unnecessary” hospital stay on completely arbitrary and frivolous grounds. They have been adopting a completely mischievous, unethical and inhumane approach while considering the request for the cashless facility of the Covid patients over hospital stay by furnishing super-medical advice, over and above the advice rendered by the medical experts, on the necessity of hospitalisation of patients,” he claimed.

Inamdar urged the court to direct the Insurance Regulatory and Development Authority of India (IRDA) to conduct an investigation under the Insurance Act and direct the insurance companies to immediately reimburse all the claims of the patients, which were arbitrarily rejected.

The applicant also requested the court to direct the Pune Municipal Corporation (PMC) to conduct an audit into affairs of all the hospitals and investigate if there is a systematic fraud played by the hospitals in connivance with the insurance companies to “exploit and unjustly enrich themselves by denying the benefits of insurance claims to the policyholders”.

It is to be noted that the Pune Municipal Corporation (PMC) had carried out an audit of hospital bills of Covid-19 patients admitted in private hospitals under its jurisdiction and reduced the bill amount of Rs 5.03 crore for 1,536 patients. In the first week of July, Rs 17.21 lakh bill amount was reduced for 188 patients, who were treated for Covid in private hospitals in the city.

Inamdar claimed that despite instructions from IRDA, the Insurance companies have been denying cashless facility to patients.

The HC has fixed the hearing in the matter after three weeks.

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