Consider AYUSH at par with Allopathy for insurance claims; fix uniform reimbursement caps: Madras High Court to IRDAI

The Madras High Court recently directed the Insurance Regulatory and Development Authority of India (IRDAI) to consider Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatments at par with allopathy while dealing with insurance claims. .In an order passed on November 21, Justice N Anand Venkatesh said it was “discriminatory” on part of insurance companies to “give preference to allopathy over AYUSH treatments,” or to fix different maximum caps and reimbursement amounts for AYUSH and Allopathy treatments in one’s insurance schemes..“The third respondent 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 allopathic 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 allopathic treatment. This has to be implemented by the third respondent in all future policies,” Justice Venkatesh said..The judge said that the insured undergoing medical treatment have the right to chose either allopathy or traditional treatments recommended under AYUSH..Justice Venkatesh further reminded IRDAI that during the COVID 19 pandemic when health services were overburdened and were treating emergency cases day and night, medical practitioners had recommended traditional treatments, home remedies and AYUSH treatments for those with milder infections..“In such circumstances, it will not be reasonable to restrict the cap and thereby deprive the policy holders to get reimbursement of the amount, which was spent by them in AYUSH hospitals,” the Court said..The Court was hearing two petitions, one filed by a lawyer and another by a clerk, seeking reimbursement of the amounts claimed by them under their respective insurance policies.During the hearing, the Court realised that as per IRDAI regulations, a cap was placed on the maximum amount of reimbursement to be provided for availing treatment at AYUSH hospitals. Such cap was much less when compared to that for allopathic treatments under similar policies, the Court noted..While in the present case, the private insurance company in question eventually drafted a comprehensive policy to cover AYUSH treatments as well.The Court then directed IRDAI to take similar steps..“There shall be a direction to the third respondent to act upon the suggestion made by this Court to place AYUSH treatment on par with allopathy treatment and direct the insurance companies to reimburse the insurance amount on equal scales. Both the writ petitions are disposed in the above terms,” the Court said..[Read Order]