In a significant ruling, the Delhi High Court has determined that while harassment experienced by patients during insurance claim approvals constitutes a valid basis for compensation, it does not amount to a criminal offence. The decision came as part of a judgment delivered by Justice Neena Bansal Krishna, who emphasized the need for smoother bill settlements and patient discharges but stopped short of criminalizing the conduct.
The case involved a lawyer who faced procedural delays and alleged harassment at a private hospital in Delhi. The lawyer, who underwent surgery in 2013, claimed that despite being covered under a cashless insurance scheme, he was compelled to pay the estimated full amount upfront. Furthermore, he was not discharged until he settled the total payment, an action he equated with cheating, misappropriation of funds, and wrongful restraint.
Justice Krishna, addressing the plea against a lower court’s decision which had refused to uphold a summons to the hospital, noted that although the plaintiff encountered procedural delays, these did not constitute a criminal offence. The court acknowledged the frequent harassment faced by patients in the settlement of final bills and emphasized the non-criminal nature of the procedural burdens placed on patients.
The hospital defended its actions by explaining that the initial authorization from the insurance was for a limited amount and a lower category room. Under the norms set by the Insurance Regulatory and Development Authority (IRDA), it was required to collect the difference between the approved amount and the actual charges before discharging the patient.
The court remarked that the requirement for patients to pre-deposit the balance amount might seem demanding but ruled that this practice could not be construed as extortionate nor indicative of any dishonest or fraudulent intentions by the hospital.
Highlighting the non-criminal yet burdensome process of settling medical bills, Justice Krishna urged the state and central governments, along with the IRDA and medical councils, to consider establishing a regulatory mechanism. This mechanism would aim to streamline the processes of hospital discharges and insurance claim approvals, alleviating the difficulties faced by patients.
