Madras High Court: In a petition filed for directing the Insurance Regulatory and Development Authority of India (‘IRDAI’), and the Secretary, Ministry of Ayush (‘MoA’), to consider the petitioner’s representation to award a full reimbursement of the claimed amount under the insurance policies, N. Anand Venkatesh, J. has directed IRDAI to place AYUSH treatment on a par with allopathic treatment and direct the insurance companies to reimburse the insurance amount on equal scales. Further, it said that a person who chooses to undergo AYUSH treatment should be entitled to receive the insurance amount towards the expenses incurred by him, as is done to a patient who undergoes allopathic treatment. This has to be implemented by IRDAI in all future policies.
The Court noted that the petitioners had taken a policy in the year 2009 and under this policy, the expenses incurred for the treatment under the system of medicines other than allopathy were excluded and it is stated that the insurance company is not liable to make any payment under the policy with respect to those expenses. Thereafter, the current policy as it stands shows that for AYUSH treatment, the maximum cap has been fixed. Further, it noted that the policies issued by the insurance company have the permission and licence of IRDAI.
The Court said that the maximum cap that was fixed under the policy has been paid to the petitioners. Hence, no further direction can be issued to the insurance company to pay the entire amount that was claimed by the petitioners.
As per the Court, there is a larger issue that is involved in this case. During Covid-19 pandemic, it is the traditional medicines that were recommended for the infected persons and the hospitals were only attending to emergency cases by providing support system, obviously, since allopathy did not have any medicine to treat covid-19 patients. It is true that such an eventuality would not have been anticipated at the time of finalizing the policy. That is the reason why the maximum cap was fixed under the policy. However, it came to light that effective treatment was also given to the infected persons under AYUSH, and it provided substantial relief to the patients.
Thus, the Court said that it will not be reasonable to restrict the cap and thereby deprive the policy holders to get reimbursement of the amount which was spent by them in AYUSH hospital.
The Court said that IRDAI must take into consideration the fact that patients can choose the type of treatment that is required for them, and they have an option to either choose allopathic medicines or go for traditional medicines provided by AYUSH. Whatever expenses are incurred for either of these treatments must be placed on equal scales. It would be discriminatory to give preference to allopathy as against AYUSH treatment. Thus, the Court asked IRDAI to keep this in mind whenever the policies are drafted and sent for approval.
The Court noted that the Star Health and Allied Insurance Company Limited has now come up with a new policy called as AYUSH plan policy, wherein even AYUSH treatment is covered, and the expenses incurred for the treatment is reimbursed. By virtue of this new policy, AYUSH treatment has been brought on a par with the allopathic treatment.
Thus, the Court directed IRDAI to place AYUSH treatment on a par with allopathic treatment and direct the insurance companies to reimburse the insurance amount on equal scales.
[K.Krishna v M.C.Uma Maheswari, 2023 SCC OnLine Mad 7522, Order dated 21-11-2023]
Advocates who appeared in this case :
For Petitioners: K.Krishna (Party-in-person)
For Respondents: Advocate K. Ravi, Advocate S. Anwarsameem, Advocate S. Jeyasingh
