Madras High Court Directs IRDAI To Treat AYUSH On Par With Allopathic Treatments For Medical Insurance Reimbursement

Stressing the work done by AYUSH doctors during the pandemic, Justice Anand Venkatesh observed that during COVID-19, traditional medicines were being recommended for infected persons and effective treatment was given under AYUSH, which provided relief to many patients.

The court thus opined that it was not reasonable to deprive policyholders of getting reimbursement for the amount spent on availing AYUSH treatments under their medical insurance. 

“During Covid-19 pandemic, it is the traditional medicines that were recommended for the infected persons and the hospitals were only attending to emergency cases by providing support system, obviously, since allopathy did not have any medicine to treat covid-19 patients. It is true that such an eventuality would not have been anticipated at the time of finalizing the policy. That is the reason why the maximum cap was fixed under the policy,” the court said.

The court also noted that it was the patients who chose the kind of treatment they wanted and that the expenses incurred during either of the treatments had to be placed on equal scales. The court added that giving preference to allopathy would be discriminatory and the same must be kept in mind by the IRDAI while drafting policies.

The court further observed that the IRDAI must encourage traditional treatments like AYUSH and those choosing to undergo AYUSH treatment should be entitled to receive the insurance amount for the expenses incurred by them.

“The third respondent (IRDAI) must bear in mind that the traditional treatment in India which falls under the head of AYUSH treatment must also be encouraged and it must get the same weightage as is given to alopathic treatment and a person, who chooses to undergo AYUSH treatment should be entitled to receive the insurance amount towards the expenses incurred by him, as is done to a patient who undergoes alopathic treatment,” the court said.

The court was hearing two pleas filed by an advocate and a clerk for full reimbursement of the amount claimed by them under their respective Insurance Policies. The court was informed that they had taken policies for a sum of Rs 5 lakh and Rs 4 lakh respectively and after getting Covid treatment at a Siddha Hospital, they sought reimbursement of their expenses. 

The insurance company submitted that the policies were governed by the regulations issued by IRDAI and as per those regulations, a cap was placed on the maximum amount of reimbursement which could be provided for availing treatment at AYUSH hospitals.

It was submitted that for policies of a sum of Rs. 5 Lakh, the maximum cap fixed was Rs. 15,000/- while for policies of Rs 4 Lakh, the maximum amount was fixed at Rs. 10,000/-, which had already been reimbursed to the petitioner.  

Looking into the policies, the court noted that the expenses incurred for treatment other than under allopathy were excluded. It noted that the maximum allotted amounts under the respective caps for AYUSH treatments had been disbursed to the petitioners, and no further directions to the insurance companies were possible.

In conclusion, the Court recorded that the insurance companies involved in the present case had drafted new policies for the comprehensive coverage of AYUSH treatments, and directed the IRDAI to ensure that the reimbursement for allopathic and AYUSH treatments took place on a similar scale. 

Counsel for the Petitioner: K.Krishna (Party-in-person)

Counsel for the Respondent: Mr.K.Ravi, Mr.S.Anwarsameem, Mr.S.Jeyasingh Special Panel Counsel for Government of India

Citation: 2023 LiveLaw (Mad) 384

Case Title: K Krishna and Another v The Managing Director and Others

Case No: W.P.(MD)Nos.18130 & 18131 of 2021