Medical insurance and health insurance services are essential services: High Court of Delhi

Medical insurance and health insurance services are essential services during the COVID-19 pandemic situation. Thus, the employees of the Petitioner company, who are dealing with medical and health insurance services, ought to be permitted to move freely between hospitals and their own offices, in order to expedite the processing of medical insurance claims.. This was held in MAX BUPA HEALTH INSURANCE CO LIMITED v. GOVERNMENT OF NCT DELHI & ANR. [W.P.(C) 5179/2021] in the High Court of Delhi by a single bench consisting of JUSTICE PRATHIBA M. SINGH.

Facts are that the Petitioner is that the company has approximately 35 personnel for the purposes of clearance of claims, and processing of cashless claims, etc., relating to health insurance and medi claim policies, the outbreak of the COVID-19 pandemic has seen an upsurge in claims being filed which are being handled at its various branch offices. Lockdown was declared by the GNCTD and only some essential services have been exempted from the lockdown in terms of the order issued. The petition has been necessitated due to the rejection of e-pass by the Delhi Government, to the employees of the Petitioner, who are required to move from place to place for clearance of the insurance claims, etc.

The counsel appearing for the petitioner, submits that the Govt. of NCT of Delhi through the Delhi Disaster Management Authority (`DDMA’) in its order dated 19th April 2021 has classified insurance companies under category 4 (l) and persons in the said categories require an e-pass in order to be able to move freely during the lockdown. The employees of the company, pursuant to the said requirement, applied to the GNCTD for an e-pass. However, all their applications have been ‘rejected’ without any reason.

The Counsel, appearing for GNCTD, submits that there are various discrepancies in the documents which have been submitted by these employees. For example, the employee is residing in one district, and he has applied for an e-pass in a different district, and such other discrepancies, due to which the issuance of e-passes is still pending.

The court made reference to the case of Vinay Jaidka v. Chief Secretary, wherein the following observations were made,“Court had directed that all insurance companies ought to process the insurance claims within a period of 30 to 60 minutes so that the discharge of patients is not delayed and hospitals beds are not blocked due to the said delay in processing the claims.”

The court also made reference to the notification/order dated 19th April 2021, imposing a curfew, as extended vide order dated 1st May 2021, issued by the DDMA- GNCTD. Considering which the court made the following observation, “The first category of individuals are those who are rendering services as specified in categories 4(a) to 4(k). Persons falling in these categories are exempted from the movement restrictions upon producing a valid Identity card/ photo entry pass/permission letters. The second category of individuals is those who fall under categories 4(l) and 4(m) for whom movement is permitted only after applying and obtaining an e-pass. Insofar as the present case is concerned, category nos. 4(d) and 4(l)(ii)”

Considering the facts of the case and keeping in mind the provisions of law applicable. The Court observed that if During the pandemic, the issuance of e-pass can be made a complex process for persons dealing with health insurance policies and claims thereunder, it would result in enormous delays. Employees of insurance companies cannot be restrained in this manner from free movement, as their movement is essential during the situation of a pandemic where many are dependent on the clearance of health insurance claims for discharge from the hospitals. The court thus disposed of the writ by issuing certain directions.

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