Reena Goel v. The Govt Of NCT Of Delhi & ORS.

$~16 * IN THE HIGH COURT OF DELHI AT NEW DELHI + W.P.(C) 5004/2022 REENA GOEL .....Petitioner Through:

Ms. Rakshita Goyal, Mr. Sanyam Gupta, Mr. Aditya Goel, Ms. Anju Bhushan Gupta and Ms. Ankita Chaudhary, Advocates.

versus THE GOVT OF NCT OF DELHI & ORS.

.....Respondents Through:

Mr. Abhishek Nanda, Ms. Hrishika Rawat and Mr. Sourabh Singh, Advocates for R-2/IRDAI.

CORAM:

HON'BLE MR. JUSTICE SACHIN DATTA

O R D E R

% 16.09.2025 1.

The present petition has been filed by the petitioner seeking appropriate directions to respondent no.3/United India Insurance Company Limited, to release the complete amount due and admissible under the insurance policy availed by the petitioner for the period 15.10.2020 to 14.10.2021. The said insurance policy has been placed on record. 2.

The policy, as originally obtained, gave coverage to the extent of Rs.3 lakhs. Admittedly, however, the petitioner availed an additional "Super Top Up Medicare Policy" for the same period, providing an additional coverage of Rs.3 Lakhs to the petitioner.

3.

The petitioner was hospitalized from 04.12.2020 till 18.12.2020 for treatment of Covid-19. In respect thereof, the concerned Hospital (respondent no.4) raised a bill amounting to Rs.3,56,295/-. However, Respondent No.3 reimbursed only Rs.1,75,340/- to the petitioner. 4.

It is submitted that the insurance company restricted the The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above.

reimbursement amount on the basis of a circular dated 20.06.2020 issued by the Government of NCT of Delhi which is in the following terms: The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above.

5.

It is submitted that a bare reading of the aforesaid circular / order indicates that it was intended to exercise control over the amount charged by the hospitals from patients who availed Covid-19 related treatment. It was not intended to curtail the coverage available to policyholders under insurance policies obtained from various Insurance Companies. 6.

During the course of hearing, it transpires that the position in this regard has been clarified by Insurance Regulatory and Development Authority of India (IRDAI) by way of a circular dated 13.01.2021, the same, inter-alia , provides as under:- 7.

Again, vide circular dated 23.04.2021, it was clarified by the IRDAI as under:

The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above.

8.

The stand of IRDAI in the present proceedings is categorical to the effect that the concerned insurance company is liable to reimburse the requisite amount to the petitioner in accordance with the coverage under the policy and the applicable terms and conditions. 9.

The circular dated 20.06.2020, issued by the Government of NCT of Delhi cannot be construed to have interdicted with the insurance contract, or the terms and conditions of the relevant insurance policy. 10.

Learned counsel appearing for the respondent no.3/ United India Insurance Limited is unable to controvert the above position. 11.

In fact, during the proceedings in W.P.(C) 7845/2021, a fair stand was taken by Mr. Pankaj Seth, learned counsel appearing for the concerned Insurance Company in that case, as recorded in the order dated 25.08.2025, which, inter-alia, reads as under:

"1.

Mr. Pankaj Seth, learned counsel for the respondent no.3 accedes that the coverage under the policy was to the tune of Rs.2.5 Lakhs out of which a sum of Rs.1.44 lakhs have been paid to the petitioner. He fairly submits that the balance amount to the extent of coverage under the policy i.e. Rs.1.06 lakhs shall be paid to the petitioner within a period of two weeks from today. It is directed, accordingly." 12.

In the present case, the bill amount of Rs.3,56,295/- was, admittedly, within the scope of the coverage obtained by the petitioner under the insurance policy issued by the respondent no.3. However, respondent no.3 reimbursed only Rs.1,75,340/-, citing the circular dated 20.06.2020 issued by the Government of NCT of Delhi. The non-release of the deficit amount is clearly unjustified and contrary to the clarification/s issued by IRDAI. The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above.

13.

In the circumstances, the respondent no.3 is directed to release the balance amount of Rs.1,80,955/- to the petitioner as expeditiously as possible and, in any event, within a period of four weeks from today. 14.

The petition is disposed of in the above terms. SACHIN DATTA, J SEPTEMBER 16, 2025/r The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above.