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Madras High Court Allows Reimbursement Claim Under NHIS 2021 for Aorto Bi-Iliac Bypass Surgery Despite Cashless Denial — Insurance Company and TPA Directed to Pay Rs.2,72,406/- with Interest. Court Held That Denial of Cashless Facility Does Not Extinguish Reimbursement Entitlement Under the Scheme.

The petitioner, P. Ravi, a Head Constable serving in the Tamil Nadu Police Department, filed a writ petition under Article 226 of the Constitution of ...

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Madras High Court Allows Medical Reimbursement Claim for Government Servant Under New Health Insurance Scheme — Rejects Rejection Based on Procedural Delay. Petitioner's Intimation of Treatment Within Time Constitutes Substantial Compliance, Entitling Her to Reimbursement with Interest.

The petitioner, P. Lakshmi, is an Assistant at the Principal District Court, Villupuram, and a member of the New Health Insurance Scheme (NHIS) admini...

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Bombay High Court Allows Widow's Claim for Medical Reimbursement Under Rajiv Gandhi Jeevandayee Arogya Yojana for Ayurvedic Treatment of Deceased Husband. Treatment at Government-Recognized Ayurvedic Hospital Held Covered Under Scheme Despite Initial Denial by Insurance Company.

The petitioner, Kiran Bhaskar Surgade, widow of Dr. B.S. Surgade, filed a writ petition seeking reimbursement of medical expenses incurred for the tre...

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Gujarat High Court Dismisses Writ Petition Challenging National Commission Order in Medical Insurance Claim Dispute. Policy Exclusion Clause for Pre-Existing Disease Upheld as Complainant Failed to Disclose Medical History.

The petitioner, Gunvantbhai Bhogilal Shah, along with his wife, availed a Group Medical Insurance Scheme from United India Insurance Co. Ltd. (respond...

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Supreme Court Allows Appeal in Mediclaim Policy Renewal Dispute — Insurer Must Disclose Material Changes in Coverage at Renewal. Renewal of Insurance Policy is Not a Fresh Contract; Insurer Owed Duty to Inform Insured of Restrictive Terms Under Principle of Utmost Good Faith.

The appellants, Jacob Punnen and his wife, held a Mediclaim policy with United India Insurance Co. Ltd. since 1982, renewed annually. In March 2008, t...

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Bombay High Court Allows CGHS Reimbursement Claim for Emergency Treatment Without Prior Referral. Petitioner's husband admitted in emergency to empanelled hospital; denial of balance reimbursement set aside.

The petitioner, Bina Saxena, is the widow of a Central Government pensioner who was a beneficiary of the Central Government Health Scheme (CGHS). Her ...

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Supreme Court Enhances Compensation for LIC Policyholder Due to Deficiency of Service in Jeevan Aastha Plan. LIC's failure to process proposal and wrongful retention of premium for five years amounts to deficiency of service under the Consumer Protection Act, 1986.

The appellant, Madhav Hari Joshi, submitted a proposal to the Life Insurance Corporation of India (LIC) under its Jeevan Aastha Plan on 31 January 200...

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Bombay High Court Dismisses Petitions Challenging ESIC Admission Classification Based on Insurable Service Duration. Classification of insured persons into Groups I, II, III based on 5/4/3 years of service held not violative of Article 14 of the Constitution of India.

The petitioners, Samiksha Dhole and Rasika Pohare, filed writ petitions challenging the admission notice dated 28.6.2017 issued by the Employees' Stat...