New Delhi: A Delhi court, in an interim order, has dismissed a medical insurance company’s attempt to challenge a charge of criminal conspiracy brought by a petitioner whose kin died following an interruption in cancer treatment.The court, taking an empathetic view, said that for families watching a loved one battle a terminal illness, a medical insurance claim file often represents “one more chance,” while a rejection is felt not as a mere policy decision but as “hope slipping away and darkness arriving a little sooner.”Judge Anuj Agrawal rejected the plea as barred by limitation after it was filed more than three years late by the company — Medi Assist Insurance TPA Pvt. Ltd.He underscored the emotional weight attached to health insurance disputes, observing how “behind every claim number lies a human story — a patient fighting pain, a family clinging to hope and loved ones exhausting every possible avenue to secure treatment in the belief that timely assistance may save a precious life.”The case dates back to 2018, when the complainant’s wife, suffering from multiple myeloma, was undergoing chemotherapy. Though earlier claims under the policy had been approved, claims relating to administration of the drug Bortezomib were repudiated, despite medical certificates clarifying that the medicine formed part of conventional and life-saving treatment.According to the complaint, repeated requests were not addressed, and the non-approval of the claims disrupted timely treatment, ultimately leading to the patient’s death on April 30, 2018.The present petition by the company challenged a 2022 magistrate order summoning it and another accused to face trial for alleged conspiracy and negligence in a medical insurance dispute.Judge Agrawal dismissed the company’s contention that the dispute was purely civil in nature, holding that the existence of a contractual relationship does not automatically extinguish criminal liability if allegations prima facie disclose ingredients of a criminal offence.The court also rejected the argument that the company merely functioned as a third party administrator. It said that records reflected its participation in processing and communicating repudiation of the claims.The court said medical insurance policies are often purchased as a promise of security during moments of greatest vulnerability. “Every approval brings hope and every rejection carries fear, uncertainty and emotional devastation,” the court said. Such disputes cannot always be reduced to mere interpretation of policy clauses, it said.The court termed the delay in filing the revision petition a result of “complete lack of due diligence,” noting that the application for condonation of delay was “conspicuously silent” regarding specific dates, steps taken, or unavoidable circumstances preventing timely filing.While the court did not conclusively uphold the allegation of criminal conspiracy at this stage, it noted that the material on record did “prima facie indicate collective and coordinated conduct” by the accused in processing the medical claim, warranting judicial scrutiny.
