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Covid insurance rejection ICMR /AIIMS guidleines


Gurlovleen
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Many insurance companies are rejecting cashless treatment claims citing ICMR /AIIMS guidelines citing that mild covid cases can be treated at home. Even people who were admitted in serious conditions , insurance claims are rejected as non-critical by govt and private insurance companies. People rush to hospital on emergency and they are not aware whether their disease is critical or non critical. Almost all patients critical or non critical are charged anywhere between 1.5 lakhs to 3.5 lakhs and treated with remdesvir, steroids and effective medicines. Can we seek information with the government or ICMR or AIIMS so as to know whether the reasons cited by insurance companies to deny claims citing ICMR guidelines is valid or not.Pls advice on drafting that could help many who are trapped in debt due to covid hospitalization charges. Can we issue a CP notice to IRDA or insurance companies. Psl advice. Even Government servants and  pensioners insurance claims are rejected by govt insurance companies  citing reasons such as covid non critical

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Edited by Gurlovleen
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Please search in google for the latest SC Judgment that irrespective of linkage of hospitals, insurance company must pay claims, once policy is accepted.

Make this as grievance with IRDI and insurance ombudsman, whether such guidelines of ICMR/AIIMS can be treated as directives for stating the denial for legitimate claim when it is a pandemic with serious after effects during and several affliction in morbid patients and also seek information from those insurance company (PSU) to provide such medical confirmation that COVID is not serious, making a mockery of such Govt lock down, curfew, restrictions at public places, hospitals etc.

File RTI Application enclosing the PSU insurance clarification asking the dept., why they are placing curbs/restrictions of public onvenience and movements when Covid is not serious and when it can spread even within family members when not isolated, as 90% of the population lives in less than 3 room accommodation.

With all this approach a consumer forum for deficiency of service.  ( after IRAI report , Ombudsman orders) and through writ against PSU in High court 

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Thanks Sirji. Will work on your inputs and file a petition for a good cause

 

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Bound to get all costs and compensation in case of favourable decision, and strictures with penalties that resorted to dilatory tactics.

(Collect as many press statements as possible by Health dept., and expert professionals from Legal field, with such GOs issued by Central Govt to States)

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