Health insurance: Govt to discuss 24-hr hospitalisation rule with Irdai
President of NCDRC, Justice Amreshwar Prasap Sahi, said that some district forums have innovated and ordered insurance cos to clear claims even when hospitalisation was less than 24 hrs
BS Web Team New Delhi Considering the advancements in the medical sciences, the consumer ministry has said that it will discuss the minimum 24-hour hospitalisation rule with the insurance regulator Insurance Regulatory and Development Authority of India (Irdai) and the Department of Financial Services (DFS), a report in The Times of India (ToI) said.
According to the ToI report, the issue was raised by the National Consumer Commission chief on Sunday, December 24. The President of the National Consumer Disputes Redressal Commission (NCDRC), Justice Amreshwar Prasap Sahi, was speaking at an event on National Consumer Rights Day where ToI quoted him as saying, "There is a condition that if one is not admitted in a hospital concerned for at least 24 hours for surgery, then the claims will not be accepted. This often comes up in case of medical claims and medical negligence cases. Some district forums innovated and ordered that even if it's 23-and-a-half hours, the claims have to be paid. They have backed this with reasoning that now several treatments can be done in less than 24 hours. So, there is no need to make the insurance companies aware of this."
Speaking to ToI, Union Consumer Affairs Secretary Rohit Kumar Singh said that we will take up the issue with Irdai and DFS to come up with a solution. Singh said that earlier, we had held discussions to introduce reforms to make documentation processes consumer-friendly.
Justice Sahi cited "landmark decisions" ordered by Punjab and Kerala district consumer commissions on cases related to medical insurance claims. The ToI report said that the Ferozpur District Consumer Commission, in August 2023, had held an insurance company liable for deficiency in service for wrongfully rejecting the complainant's medical claim based on the duration of hospitalisation being less than 24 hours.
Consumer Affairs Secretary Singh praised the judgments by consumer commissions at the district and state levels, which have resulted in the disposal of 177,000 complaints this year against the filing of 161,000 fresh cases. In the case of NCDRC, the case disposal rate is 200 per cent, the ToI report stated.