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Health insurance claim agents to be considered as rendering essential services whilst lockdown: Delhi High Court

The present petition before the Delhi High Court deals with mobility issues arising out of the current Covid-19 scenario in India where numerous states are imposing lockdown. The matter before the bench of Pratibha M. Singh J. dealt with the allowance of insurance agents to move around as insurance claims form an unavoidable part of the current situation; which was duly observed in Max Bupa Health Insurance Co. Ltd v Government of NCT Delhi [W.P.(C) 5179/2021].

The Petitioner, in the present petition, is a leading insurance company which is engaged in the business of health insurance plans and mediclaim policies. As part of its everyday operations, the employees of the Petitioner deal with issuance of medical/healthcare policies, cashless claims requests and claims from policy-holders. These claims are filed through online platforms as also through courier, post, by hand and are stated to be submitted by policy holders, their family members or their agents even at hospitals & like establishments as also at the Petitioner’s branch offices.

It is the case of the Petitioner that 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 on 19th April 2021 and only some essential services have been exempted from the lockdown in terms of the order issued. The present 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.

It was argued on behalf of the petitioners 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 reasons.

The bench perused the notification/order dated 19th April, 2021, imposing curfew, as extended vide order dated 1st May, 2021, issued by the DDMA GNCTD, there were two classes of individuals who were granted exemption from the curfew restrictions. The category of individuals was those who were rendering services as specified in categories 4(a) to 4(k). Persons falling in these categories were exempted from the movement restrictions upon producing a valid Identity card/ photo entry pass/permission letters. The Respondent- GNCTD, trreated all the employees of the Petitioner under clause 4(l)(ii).

The court was of the opinion that, to the extent that the employees of the Petitioner were dealing with processing and clearing of claims relating to health insurance policies or Mediclaim policies and like policies, the said services would be incidental to the other services as mentioned in clause 4(d), and ought not to be treated as equivalent to general insurance services which are being given.

Medical insurance and health insurance services are essential services during the COVID-19 pandemic situation. Thus, the employees of the Petitioner company, who were 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.

Accordingly, the court ruled that, “The employees of the Petitioner, who are dealing with health insurance claims, as also mediclaims etc., and are processing the claims of patients, who are admitted in hospitals or otherwise, shall be considered as rendering essential services, and shall be deemed to be covered under Entry No. 4(d) of the order passed by the DDMA, GNCTD dated 19th April, 2021.”

Click here to read the judgment.

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