COMMON ORDER

When the matters came up for hearing on 16.11.2023, this Court passed the following order:-

“These writ petitions have been filed for the issue of a writ of mandamus directing the M/s.Star Health and Ailled Insurance Company to award full reimbursement of the amount claimed by the petitioners under the Insurance Policies.

2.The case of the petitioners is that they have policies with M/s. Star Health and Ailled Insurance Company. Insofar as the petitioner in W.P(MD)No.18130 of 2021, who is an Advocate practicing before this Court, he has taken a policy in the year 2009 for a sum of Rs.5 lakhs. Similarly, the petitioner in W.P(MD)No.18131 of 2021 is the Advocate Clerk for whom policy has taken in the same Company for a sum of Rs.4 lakhs. During the Covid-19 pandemic, both the petitioners were infected and they underwent treatment in Siddha Hospital.

3.The petitioner in W.P(MD)No.18130 of 2021 had sought for reimbursement of a sum of Rs.52,250/-, which was incurred towards treatment. Similarly, the petitioner in W.P(MD)No.18131 of 2021 had also sought for reimbursement of a sum of Rs.52,250/-. In the first case, only Rs.15,000/- was reimbursed and in the second case, only a sum of Rs.10,000/-

was reimbursed.

4.It was submitted that when the policies were taken in the year 2009, it did not provide for any separate cap for reimbursement towards treatment taken in AYUSH Hospital and the same was treated on par with Allopathy treatment. Therefore, it was contended that whatever amount was spent towards the treatment in Siddha Hospital must be reimbursed by the Insurance Company.

5.Per contra, the learned counsel appearing for the Insurance Company submitted that the Policies are governed by the regulation issued by IRDA from time to time and as per the same, for the policy of sum of Rs.5 lakhs, the maximum cap is fixed at Rs.15,000/- and for the policy of Rs.4 lakhs, the maximum cap is fixed at Rs.10,000/- wherever the treatment is taken at AYUSH and the same has already been reimbursed to the petitioners.

6.To decide these writ petitions, the terms of the policy must be placed before this Court. The petitioners sought for some time to place the relevant documents before this Court. The learned counsel appearing for the Insurance Company is also directed to place the relevant materials before this Court to substantiate the stand taken by the Insurance Company to the effect that there is a maximum cap, that is fixed for treatment undergone at AYUSH Hospital

7.Post the matters under the caption ‘Part Heard Cases’ on 21.11.2023.”

2. When the matter was taken up for hearing today, the learned counsel appearing on behalf of the Insurance Company produced the relevant insurance policies. Admittedly in this case, the petitioners had taken a policy in the year 2009 and under this policy, the expenses incurred for the treatment under the system of medicines other than allopathy were excluded and it is stated that the insurance company is not liable to make any payment under the policy with respect to those expenses. Thereafter, the current policy as it stands shows that for AYUSH treatment, the maximum cap has been fixed and for the sum insured upto Rs.4,00,000/-, the limit is fixed upto Rs.10,000/-. For the sum insured from Rs.5,00,000/- to Rs.15,00,000/-, the limit is fixed upto Rs.15,500/-. For the sum insured from Rs.20,00,000/- to Rs.25,00,000/-, the limit is fixed upto Rs.20,000/-. It is also clear that the policies issued by the insurance company have the permission and licence of the Insurance Regulatory and Development Authority of India (IRDAI).

3. In the light of the above policies that were produced before this Court, it is clear that whatever was the maximum cap that was fixed under the policy has been paid to the petitioners. Hence, no further direction can be issued to the insurance company to pay the entire amount that was claimed by the petitioners.

4. There is a larger issue that is involved in this case. During Covid-19