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Saket District Court of the country’s capital Delhi has given a very sensitive and historic decision regarding health insurance. In this important decision, the court has clearly said that health insurance claim cannot be seen as merely a paper process or merely a part of a contract. It is a great support for any patient and his family in difficult times.

The court made this scathing comment during the hearing of a tragic case in which, due to the insurance claim being rejected during treatment, the condition of a female patient continued to deteriorate and ultimately she died. In this case, the insurance company has been facing serious allegations like negligence and endangering the life of the patient.

The hope of a family is hidden behind every mediclaim file.

Hearing this case, the court of Additional Sessions Judge Anuj Aggarwal outright rejected the revision petition filed by Medi Assist Insurance TPA Private Limited. The court said in a very emotional but strict tone that behind every mediclaim file, there are not just papers, but the hopes of a family and their hard struggle are hidden. When a family sees their loved one suffering and struggling with a serious illness, rejection of the mediclaim at such a critical time is not just a violation of a policy condition, but is like the loss of the last hope of that family. This entire matter of claim is directly to the life expectancy of the patient and his family.

The court showed strong displeasure over the long delay of three years

This whole matter started when a husband, desperate for justice after the death of his wife, approached the lower court. Considering the seriousness of the matter, the trial court had issued summons against the insurance company and its Third Party Administrator (TPA) in April 2022 itself on charges of criminal conspiracy and endangering someone’s life by negligence.

To avoid this action, the TPA company filed a revision petition in the sessions court after a long delay of about three years. But the Sessions Court took a very strict stance on this delay of the company and clearly refused to forgive this huge delay. The court completely rejected the company’s petition and said that now the companies concerned will have to face the case before the court.

A woman suffering from cancer died due to not getting timely help.

This entire painful case is to Dharamveer Singh, resident of Kalkaji area of ​​Delhi, and his late wife Sushma Saini. Sushma Saini was suffering from a fatal disease like multiple myeloma, a type of extremely serious blood cancer, and was undergoing treatment through chemotherapy in the hospital. In the initial days of treatment, the insurance company passed some claims and paid the claim amount, but later they backed off.

When doctors prescribed a vital life-saving drug called ‘Bortezomib’ to save the patient’s life, the insurance company repeatedly rejected its claim. Whereas the doctors of the hospital had also explained to the company in writing that this medicine is extremely necessary to keep the patient alive. Due to not getting the money from the insurance company on time, the woman’s treatment was completely affected and due to lack of money and proper treatment, Sushma finally died in the year 2018.

Now it is hoped that after this very strict and sensitive decision of the country’s court, the insurance companies busy in earning profits will be a little serious and will think a little sensitively about the interests and compulsions of their consumers.