Medical/Health Insurance Essential Services During COVID, Employees Of Insurance Companies Can't Be Restrained From Free Movement: Delhi HC

The Bench of Justice Prathiba M. Singh was dealing with a plea filed by the Petitioner Insurance Company, Max Bupa Health Insurance Co Limited which is engaged in the business of health insurance plans and mediclaim policies.

The Bench also observed that during the pandemic, the issuance of an e-pass should not be made a complex process for persons dealing with health insurance policies and claims as it would result in enormous delays.

The grievance of the Petitioner-Insurance Company

It was submitted that the company has approximately 35 personnel for the purposes of clearance of claims, and processing of cashless claims etc., relating to health insurance and mediclaim policies, for various patients who are primarily suffering from COVID-19 and are admitted in various hospitals.

The petition had been filed due to the rejection of e-pass by the Delhi Government, to the employees of the Petitioner, who are required to move from place to place for clearance of the insurance claims etc.

The Counsel for the company submitted that the Govt. of NCT of Delhi [through the Delhi Disaster Management Authority (`DDMA')] vide its order dated 19^th April, 2021 had classified insurance companies under category 4 (l) and the persons in the said categories require an e-pass in order to be able to move freely during the lockdown.

However, when the employees of the company, pursuant to the said requirement, applied to the GNCTD for an e-pass, all their applications were 'rejected' without any reasons

Delhi Govt's order

There are two classes of individuals who are granted exemption from the curfew restrictions by the Delhi Government.

The first category of individuals are those who are rendering services as specified in categories 4(a) to 4(k) and the persons falling in these categories are exempted from the movement restrictions upon producing a valid Identity card/ photo entry pass/permission letters.

The second category of individuals are those who fall under categories 4(l) and 4(m) for whom movement is permitted only after applying and obtaining an e-pass.

Now, GNCTD, was treating all the employees of the Petitioner under clause 4(l)(ii) and thus required e-pass and that too was denied.

Court's observations

At the outset, the Court opined that to the extent that the employees of the Petitioner are dealing with processing and clearing of claims relating to health insurance policies or Mediclaim policies and like policies, the said services would be incidental to the other services as mentioned in clause 4(d), and ought not to be treated as equivalent to general insurance services that are being given (thus not requiring passes).

Thus, the court remarked,

"The employees of the Petitioner company, who are dealing with medical and health insurance services, ought to be permitted to move freely between hospitals and their own offices, in order to expedite the processing of medical insurance claims."

Importantly, the Court also remarked,

"The employees of the Petitioner, who are dealing with health insurance claims, as also mediclaims etc., and are processing the claims of patients, who are admitted in hospitals or otherwise, shall be considered as rendering essential services and shall be deemed to be covered under Entry No. 4(d) of the order passed by the DDMA, GNCTD dated 19th April, 2021."

Lastly, in order to ensure that there is a proper record of the said employees, the Petitioner company was directed to give a complete list of the employees along with their relevant data that all the said employees would be dealing with the processing and clearance of claims relating to health insurance or Mediclaim policies.

Now, as per the court's order, the said employees, after the documents having been submitted to the official concerned, shall be exempted from the curfew restrictions, as they would be deemed to be covered under entry no.4(d) of the order dated 19th April, 2021, passed by the GNCTD.

With these observations, the instant petition and all pending applications were disposed of.

Case title - Max Bupa Health Insurance Co Limited v. Government of NCT Delhi and Anr.

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