Employees dealing with health insurance claims are deemed to be rendering essential services and are exempted from curfew restrictions under the Disaster Management Act, 2005.

JUDGMENT

Prathiba M. Singh, J. - This hearing has been done through video conferencing.

CM APPL. 15898/2021 (for exemption from filing duly affirmed affidavits)

2. This is an application seeking exemption from filing duly attested affidavits. Binding the deponent of the affidavits to the contents of the application, the exemption is granted. However, the physical copy of the attested affidavits be filed in the Registry within two weeks after the physical court functioning resumes. Application is disposed of.

WP(C) 5179/2021 & CM APPL. 15897/2021 (for interim relief)

3. The Petitioner, in the present petition, is a leading insurance company which is engaged in the business of health insurance plans and mediclaim policies. As part of its everyday operations, the employees of the Petitioner deal with issuance of medical/healthcare policies, cashless claims requests and claims from policy-holders. These claims are filed through online platforms as also through courier, post, by hand and are stated to be submitted by policy holders, their family members or their agents even at hospitals & like establishments as also at the Petitioner's branch offices. It is pleaded that in Delhi, the Petitioner has various branch offices from where the receipt, processing and approval of claims is carried out after collating the documents.

4. The case of the Petitioner is 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 Petitioner has branches all over Delhi, with approximately 256 employees, however only around 30 to 35 officials are required to attend offices, in order to process the claim documents of these patients.

5. It is the case of the Petitioner that the outbreak of the COVID-19 pandemic has seen an upsurge in claims being filed which are being handled at its various branch offices. Lockdown was declared by the GNCTD on 19th April 2021 and only some essential services have been exempted from the lockdown in terms of the order issued. The present petition has been necessitated 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.

6. Reference is also made to the order dated 28th April, 2021 in WP(C) 5026/2021 titled Vinay Jaidka v. Chief Secretary, wherein this Court had directed that all insurance companies ought to process the insurance claims within a period of 30 to 60 minutes, so that the discharge of patients is not delayed and hospitals beds are not blocked due to the said delay in processing the claims.

7. It is stated that the IRDAI has also issued directions vide circular dated 29th April, 2021, which reads as under:-

"1. Reference is invited to Order dated 28.4.2021 passed by Hon'ble High Court of New Delhi in WP(C) No. 5026/2021 wherein IRDAI was directed to advise Insurers to communicate their cashless approvals to the concerned hospitals/establishments within a maximum time period of 30 to 60 minutes so that there shall not be any delay in discharge of patients and hospital beds do not remain unoccupied.

2. In this regard, attention is invited to circular ref.no. IRDAI/HLT/MISC/CIR/95/04/2020 dated 18.4.2020 wherein a fixed turnaround time (TAT) of two hours for granting both cashless preauthorization and for final discharge of the insured patient was specified.

3. In the wake of prevailing conditions of COVID-19 cases in the form of second wave and in line with aforesaid directions of the Hon'ble High Court, the following directions are issued to all insurers:

a. Decision on authorization for cashless treatment for COVID-19 claims shall be communicated to the network provider (hospital) within a period of 60 minutes from the time of receipt of authorization request along with