Case Title: K Krishna and Another v The Managing Director and Others
Summary
The Madras High Court has called for the Insurance Regulatory and Development Authority of India (IRDAI) to treat AYUSH treatments equally with Allopathy treatments and reimburse expenses incurred during treatment. Justice Anand Venkatesh highlighted the contributions of AYUSH physicians during the pandemic, stating that traditional remedies were prescribed for infected individuals and effective treatment was administered under AYUSH. The court concluded that it was unreasonable to deny policyholders reimbursement for the amount they spent on AYUSH treatments under their medical insurance. The court also noted that patients were the ones who selected the type of treatment they desired, and that the expenses associated with either treatment had to be compared on an equal basis. The court also instructed the IRDAI to ensure that reimbursement for allopathic and AYUSH treatments was conducted on a comparable scale.
About the case
The Madras High Court has requested that the Insurance Regulatory and Development Authority of India (IRDAI) treat AYUSH treatments on an equal footing with Allopathy treatments and reimburse expenses incurred during treatment, a significant development.
Justice Anand Venkatesh underscored the contributions of AYUSH physicians during the pandemic, noting that, during COVID-19, traditional remedies were prescribed for infected individuals, and effective treatment was administered under AYUSH, which relieved numerous patients.
The court therefore concluded that it was unreasonable to deny policyholders reimbursement for the amount they spent on AYUSH treatments under their medical insurance.
“During the Covid-19 pandemic, traditional medicines were the recommended treatment for infected individuals, and hospitals were only able to attend to emergency cases by providing a support system. This was due to the fact that allopathy did not have any medicine to treat Covid-19 patients.” It is true that such an eventuality would not have been foreseen at the time of policy finalization. The court stated that this is the reason the utmost cap was established under the policy.
The court also observed that the patients were the ones who selected the type of treatment they desired, and that the expenses associated with either treatment had to be compared on an equal basis. The court further stated that the IRDAI must consider the potential discriminatory implications of favoring allopathy when formulating policies.
The court also noted that the IRDAI should promote traditional treatments such as AYUSH and that individuals who elect to undergo AYUSH treatment should be entitled to obtain the insurance amount for the expenses they incur.
The court stated that the third respondent (IRDAI) must consider the fact that the traditional treatment in India, which falls under the category of AYUSH treatment, must also be encouraged and given the same weightage as allopathic treatment. Additionally, a person who elects to undergo AYUSH treatment should be entitled to receive the insurance amount to cover the expenses incurred, as is the case for a patient who undergoes allopathic treatment.
The court was currently hearing two pleas from a clerk and an advocate, both of whom were seeking complete reimbursement for the amount they claimed under their respective insurance policies. The court was informed that they had purchased policies for Rs 5 lakh and Rs 4 lakh, respectively, and that they sought reimbursement for their expenses after receiving Covid treatment at a Siddha Hospital.
The insurance company argued that the policies were subject to the regulations established by IRDAI, which stipulated a maximum reimbursement amount for treatment at AYUSH hospitals.
It was submitted that the maximum limit for policies with a sum of Rs. 5 Lakh was Rs. 15,000/-, while the maximum cap for policies with a sum of Rs. 4 Lakh was Rs. 10,000/-. The petitioner had already been reimbursed these amounts.
The court observed that the expenses associated with treatment that was not under allopathy were not included in the policies. It was observed that the petitioners had received the utmost allotted amounts for AYUSH treatments under the respective caps, and no additional instructions could be given to the insurance companies.
In summary, the Court noted that the insurance companies involved in the current case had developed new policies to provide comprehensive coverage of AYUSH treatments. It also instructed the IRDAI to ensure that the reimbursement for allopathic and AYUSH treatments was conducted on a comparable scale.
