Nagaland health claims row: HC orders insurer to explain 4,743 pending cases

KOHIMA — The Kohima Bench of Gauhati High Court has directed the insurance company implementing Nagaland’s health insurance scheme to file an affidavit within three weeks explaining the status of 4,743 pending claims amounting to INR 17.1 crore.

The order came during the hearing of a public interest litigation concerning delays in settlement of claims under the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana and Chief Minister’s Health Insurance Scheme, and allegations of non-payment of bills to empanelled hospitals by Generali Central Indian Insurance Co. Ltd.

The matter was heard by a division bench comprising Justice N Unni Krishnan Nair and Justice Yarenjungla Longkumer on May 20.

According to the court order, N Mozhui, standing counsel appearing for the Nagaland Health Protection Society (NHPS), placed before the court compiled data relating to claims submitted to the insurer and the claims that had been cleared.

Also read: Accessibility can’t be an afterthought — Nagaland PwD commissioner

Healthcare stretched thin across Nagaland, CAG report reveals

Referring to the data, the court recorded that 4,743 claims involving INR 17,10,85,457 remained pending with the insurance company.

Taking note of the submissions, the court directed counsel for Nagaland Health Protection Society (NHPS) to share the compiled data with counsel representing the insurance company and other parties appearing in the case.

The bench further ordered the insurance company to submit an affidavit addressing the pending claims within three weeks from May 20.

The court also granted liberty to other respondents to place on record their respective positions based on the disclosures contained in the data compiled by NHPS. The case has been listed for further hearing on June 17.