The Bombay High Court allowed the Maharashtra government to intervene in a public interest litigation about the problems faced by Mediclaim policy holders.
The government told a bench headed by Chief Justice Mohit Shah that it wanted to intervene to protect its own scheme, ‘Rajiv Gandhi Jeevandayi Arogya Yojnaa’, meant for the persons below the poverty line.
The bench allowed the government to intervene, adjourning the hearing of the PIL, filed by city-based activist Gaurang Damani, for three weeks.
Earlier, the court had asked the Insurance Regulatory and Development Authority to find out whether the insurance firms had issued guidelines to third party administrators (TPA) on how to recommend claim amounts for Mediclaim and other health insurance policies.
In December 2012 the HC had directed IRDA to frame regulations for health insurance policies. Accordingly, the authorities came out with regulations in February 2013.
Damani had pointed out that IRDA lawyer assured the court that TPAs would not settle the claim amounts, but the section 12(b) of regulations says that TPAs ‘would recommend’ the claims based on certain guidelines.
There were no guidelines on the basis of which TPAs were authorised to recommend the claims, he added. The court had then directed the IRDA to find out whether such guidelines had been issued to TPAs.
Damani had also pointed out that as per an IRDA affidavit, there were six lakh health insurance claims pending in 2013, involving the sums totalling Rs. 1,200 crore. He alleged that this was because TPAs were settling the claims and not the insurance firms.
