Psychiatric Treatment Requiring Hospitalization Can Be Covered Under Mediclaim If Policy Terms Do Not Explicitly Bar Such Cases: J&K High Court
2 weeks, 1 day ago

Psychiatric Treatment Requiring Hospitalization Can Be Covered Under Mediclaim If Policy Terms Do Not Explicitly Bar Such Cases: J&K High Court

Live Law  

The Jammu and Kashmir High Court held that if hospitalization is deemed necessary by medical experts, insurance companies cannot deny claims solely on the basis of exclusion clauses without proper justification. BACKGROUND: The respondent filed a consumer complaint against National Insurance Co. Ltd., claiming reimbursement under a Mediclaim Insurance Policy for treatment expenses related to major depressive disorder and schizophrenia. The insurance claim was rejected by National Insurance Co. Ltd., stating that psychiatric and psychosomatic disorders were excluded under Clause 4.8 of the policy and that outpatient treatment was not covered. On appeal, the Jammu & Kashmir State Consumer Disputes Redressal Commission overturned the forum's decision and directed the insurer to reimburse the medical expenses along with 8% interest and additional damages of ₹30,000. FOR RESPONDENTS Case-Title: National Insurance Co. Ltd. Vs Jammu and Kashmir State Consumer Disputes Redressal Commission & ORS, 2025 2025 LiveLaw 85 Click Here To Read/Download Order

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History of this topic

Excluding Psychiatric Treatment From Medical Reimbursement Schemes Violates Mental Healthcare Act: Jharkhand High Court
1 month, 2 weeks ago

Excluding Psychiatric Treatment From Medical Reimbursement Schemes Violates Mental Healthcare Act: Jharkhand High Court

Live Law  

The Jharkhand High Court has held one cannot be denied reimbursement for expenses incurred to get treatment for mental health, ruling that excluding psychiatric treatment from medical reimbursement schemes violates the Mental Healthcare Act, 2017. Clause 6.3 of the CPRMS, which denies reimbursement of any expenses incurred by the member for psychiatric treatment is directly in conflict with various provisions …

Insurance Agents Liable For Errors In Insurance Applications, Must Provide Diligent Assistance To Customers: Jammu & Kashmir High Court
1 year, 7 months ago

Insurance Agents Liable For Errors In Insurance Applications, Must Provide Diligent Assistance To Customers: Jammu & Kashmir High Court

Live Law  

The Jammu and Kashmir High Court recently held that insurance agents are required to provide careful and diligent assistance to customers while helping them complete insurance applications as intermediaries between clients and insurance companies. Therefore, we do not find any force in the argument of learned counsel for National Insurance Company that it was claimant-Inderjeet Singh who had wrongly written …

Reimbursement Of Medical Claim By Govt Employees Should Not Be Denied Mechanically: Gujarat High Court Reiterates
2 years, 7 months ago

Reimbursement Of Medical Claim By Govt Employees Should Not Be Denied Mechanically: Gujarat High Court Reiterates

Live Law  

The Gujarat High Court has reiterated that a Government employee is entitled to avail the benefits of medical facilities without any fetters, and that their claim for reimbursement should not be denied by the State mechanically.The Bench of Justice Biren Vaishnav extensively relied on the decision of a Coordinate Bench in Chanrakant Kantilal Dave v. State of Gujarat to order …

Insurance firm directed to settle claims of patient
2 years, 10 months ago

Insurance firm directed to settle claims of patient

Deccan Chronicle  

Hyderabad: The District Consumer Disputes Redressal Commission-I directed the State Bank of India General Insurance to pay Rs 1,47,343 along with an interest at nine per cent for failing to settle the claims of a person who was insured with them and had undergone treatment. They filed a petition before the commission against Paramount Health Services and Insurance TPA services, …

Insurance firms to comply with mental health Act: HC
3 years, 11 months ago

Insurance firms to comply with mental health Act: HC

The Hindu  

The Delhi High Court on Monday said that insurance companies are liable to give effect to the Mental Healthcare Act 2017 in their policies from the time it came into force in 2018. The High Court’s directions came on a woman’s plea whose claim for reimbursement of costs for treatment of schizophrenia were rejected by the National Insurance Company Ltd …

Explain basis for approving insurance policies excluding mental illnesses from full coverage: HC to IRDA
3 years, 11 months ago

Explain basis for approving insurance policies excluding mental illnesses from full coverage: HC to IRDA

The Hindu  

The Delhi High Court has asked insurance sector regulator IRDAI to explain on what basis it was approving insurance policies that excluded mental conditions from full coverage. The direction to the Insurance Regulatory and Development Authority of India by the court came on a plea of a man whose claim for reimbursement of costs in the treatment of his mental …

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