Insurance company cannot unduly restrict interpretation of health insurance policy: High Court
The Karnataka High Court ruled that insurance companies cannot deny claims for life-sustaining treatments simply because they are administered as outpatient procedures. The court upheld a decision to reimburse a cancer patient for expensive injections.
Why it matters
This ruling sets a legal precedent protecting patients from restrictive insurance policies that prioritize hospital admission criteria over medical necessity.
Turning down an appeal by National Insurance Company, the Karnataka High Court said the insurer cannot adopt an unduly restrictive interpretation of the insurance policy merely because treatment for serious ailment of the insured person can be administered without hospitalisation.
The Judge Suraj Govindaraju on September 1 upheld the order of Permanent Lok Adalat, Mangaluru, directing the insurance firm to reimburse the medical expense incurred by 72-year-old retired Vijay Bank officer Padmanabha Shetty G. towards post-chemotherapy injections Zoladex and Xgeva. The Judge said Permanent Lok Adalat has not committed any error of law or jurisdiction, nor has it adopted a view which warrants interference in exercise of the writ jurisdiction of the High Court. The High Court dismissed the writ petition of the insurance firm by imposing cost of ₹50,000.
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