New Delhi: Harassment faced by a client during the approval of insurance claims in a hospital can be a ground for seeking compensation but does not amount to a criminal offence, the Delhi High Court has said.
The court, at the same time, said patients frequently suffered harassment in the settlement of final bills and the issue of smoothening settlement of bills and discharge of patients should be taken up by authorities.
Justice Neena Bansal Krishna made the observations while dealing with a lawyer’s plea against a sessions court order refusing to uphold the summons issued to a private hospital here by a magisterial court on his complaint.
The lawyer, who had undergone surgery at the private hospital in 2013, accused it of cheating, misappropriation of funds and wrongful restraint.
He alleged that despite having the authorisation under the cashless insurance scheme offered by a private insurance company, he was made to deposit the entire estimated amount before surgery, and he was subsequently not discharged until the entire payment was cleared under the policy.
The court, in the judgement passed on April 17, said although there was procedural delay, no offence, as alleged by the petitioner, was made out and refused to interfere with the sessions court’s decision.
The hospital submitted that it committed no offence as the initial authorisation was only for a limited amount and for a lower category room, and according to the norms of the Insurance Regulatory and Development Authority (IRDA), the difference in price approved and the actual charges were required to be taken from the patient before his discharge.
The court said the condition to pre-deposit the balance amount might seem onerous, but could neither be said to be extraction of money nor could any dishonesty or fraudulent intention be attached to the hospital, in this regard.
In the order, the court nonetheless acknowledged the harassment and trauma experienced by patients in setting their bills with the insurance companies, saying that is “riddled with delays”.
“Much angst has been expressed on this system of getting the approvals from the insurance company at many forums and by the courts, but such situation may be a ground for seeking compensation for mental harassment but does not tantamount to any criminal offence,” the court said.
“Though many a times courts have recommended that there may be some regulatory policy and even a Charter of Patients’ Rights has been proposed by NHRC, but unfortunately no final redressal to this aspect has been worked out till date.
“It is a matter which must be taken up at the level of state government/central government in consultation with IRDA and the Medical Council of Delhi and India, to work out some mechanism to smoothen the discharge process and settling of the medical Bills,” it said.
