Essential medical/health insurance services during COVID, insurance company employees cannot be restricted from moving freely: Delhi HC

Emphasizing that medical insurance and health insurance services are essential services during the COVID-19 pandemic situationthe The Delhi High Court on Thursday, May 6 observed that the employees of insurance companies cannot be prevented from moving freely, as their movement is essential in a pandemic situation.

The bench of Judge Prathiba M. Singh dealt with a plea filed by the Petitioner Insurance Company, Max Bupa Health Insurance Co Limited which is engaged in the business of health insurance plans and health insurance policies.

The Chamber also observed that during the pandemic, issuing an electronic pass should not become a complex process for people dealing with health insurance policies and claims. because that would cause huge delays.

The grievance of the applicant-insurance company

It was stated that the company has approximately 35 employees for the purpose of settling claims and handling cashless claims etc. relating to health and mediclaim insurance policies, for various patients mainly suffering from COVID-19 and admitted to various hospitals.

The petition was filed due to the rejection of e-pass by the Delhi government, to the employees of the petitioner who are required to travel from place to place for the settlement of insurance claims etc..

The company’s attorney argued that the government. from NCT Delhi [through the Delhi Disaster Management Authority (`DDMA’)] see its decree of 19and April 2021 had classified insurance companies in category 4 (l) and people in said categories need an e-pass to be able to move freely during confinement.

However, when the employees of the company, in accordance with the said requirement, applied to GNCTD for an e-pass, all their applications were “rejected” without any reason.

Delhi Government Ordinance

There are two categories of individuals who are exempt from curfew restrictions by the Delhi government.

The first category of individuals are those who render services as specified in categories 4(a) to 4(k) and persons falling into these categories are exempt from movement restrictions upon presentation of a valid identity card /entrance card with photo/authorization letters .

The second category of individuals are those who fall under categories 4(l) and 4(m) for whom travel is only authorized after having requested and obtained an e-pass.

Now, GNCTD treated all of the claimant’s employees under clause 4(l)(ii) and therefore required an electronic pass, which it was also denied.

Court’s observations

Initially, the Court considered that to the extent that the employees of the Petitioner are involved in the processing and settlement of claims relating to health insurance policies or Mediclaim policies and similar policies, such services would be incidental to the other services referred to in clause 4(d) and should not be treated as equivalent to the general insurance services which are provided (thus not requiring a pass).

Thus, the court noted,

Employees of the applicant company, who deal with medical and health insurance services, should be allowed to move freely between hospitals and their own offices, in order to expedite the processing of medical insurance applications..”

Importantly, the Court also noted that

Employees of the Applicant, who handle health insurance claims, as well as medical claims, etc., and process claims for patients, who are admitted to hospitals or otherwise, will be deemed to render essential services and will be deemed to be covered under entry no. 4(d) of the decree passed by the DDMA, GNCTD dated April 19, 2021.”

Lately, in order to ensure that there is a proper record of said employees, the claimant company was requested to provide a complete list of employees along with their relevant data that all said employees would deal with in handling and settling claims relating to insurance policies health insurance or Medicclaim.

Now, in accordance with the court order, the said employees, after the documents were presented to the concerned official, will be exempt from the curfew restrictions, as they would be deemed to be covered by entry No. 4 (d) of the order of April 19, 2021, adopted by the GNCTD.

With these submissions, this motion and all pending claims have been disposed of.

Case Title – Max Bupa Health Insurance Co Limited v. Government of NCT Delhi and Anr.

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Michelle J. Kelley