Mr. Anupam Dwivedi and Mr. Ashutosh Kumar, Advocates v. THE GOVT. OF NCT OF DELHI AND ORS

$~15 * IN THE HIGH COURT OF DELHI AT NEW DELHI + W.P.(C) 7845/2021 and CM APPL.41982/2023 SUNITA GOEL AND ORS .....Petitioners Through: Mr. Anupam Dwivedi and Mr. Ashutosh Kumar, Advocates. versus THE GOVT. OF NCT OF DELHI AND ORS .....Respondents Through: Mr. Anubhav Gupta, Panel Counsel (Civil-GNCTD) for R-1. Mr. Abhishek Nanda, Ms. Hrishika Rawat and Mr. Sourabh Singh, Advocates for R-2/IRDAI. Mr. Arjun Dewan, Mr. Akash Arora and Mr. Kartik Sharma, Advocates for R-4. CORAM: HON'BLE MR. JUSTICE SACHIN DATTA % 16.09.2025 O R D E R 1. The present petition has been filed by the petitioners, inter-alia, seeking the following prayers: “i. issue an appropriate Writ/order/direction in nature of mandamus or other appropriate Writ, quashing the letter dated 31.12.2020 sent by the Respondent No.3 to the Petitioner No.1 and further directing the Respondent No.3 to reimburse/make the payment to the PetitionerNo.1, in view of the circular No. lRDAIIHLT/REG/CIRl054/03/2020dated 04.03.2020 issued by the Respondent No.2, qua the BillNo.1003/20/I/Cr/ 0001829 dated 08.07.2020 raised by the Respondent No.4 / hospital; Or / Alternatively issue an appropriate Writ / order / direction in nature of mandamus or other appropriate Writ, quashing/setting aside the BillNo.1003/20/I/Cr/0001829 dated 08.07.2020, raised by the Respondent No.4 in contravention of the circular/guidelines issued by the Respondent No.1 vide order no.52/ DGHS/PH-IV/COVID19/2020/prsecyhfw/14450-14649 dated 20.06.2020, and further directing the Respondent No.4 to return/repay the money to the Petitioner No.1, which the Respondent No.4 has collected in excess of the said circular no.52/ DGHS/PH-IV/COVID-19/2020/prsecyhfw/14450-14649 dated 20.06.2020; and ii. issue an appropriate Writ/order/direction in nature of mandamus or other This is a digitally signed order. The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 24/09/2025 at 13:08:27 appropriate Writ, directing the Respondent No.1 to take strict legal action(s) against the Respondent No.4 for violating the circular/guidelines no.52/ DGHS/PH-IV/COVID-19/2020/prsecyhfw/14450-14649 dated 20.06.2020 and further to ensure its compliance within the territory of NCT of Delhi so that no private hospital may fetch/extort exorbitant charges for COVID-19 treatment; and iii. issue an appropriate Writ/order/direction in nature of mandamus or other appropriate Writ, directing the Respondent No.2 to take strict legal action(s) against the Respondent No.3 for violating the circular/guideline No. IRDAII HLT/ REG/ CIR/ 054/ 03/ 2020 dated04.03.2020 and further to ensure its compliance so that no insurer may escape from its liability of making payment, in view of the policy issued, towards the treatment of the insured COVID-19patients; and iv. issue an appropriate Writ/order/direction in nature of mandamus or other appropriate Writ, directing the Respondent Nos.3-4 to, jointly and severally, pay a compensation of Rupees Twenty Five Lakhs to the Petitioners for causing extreme mental agony, pain and harassment; and” 2. The factual background canvassed by the petitioners is that Shri Gulshan Kumar Goel, the deceased husband of petitioner no.1 was insured under a mediclaim policy titled "Parivar Mediclaim Policy" bearing Policy No. 360800501910001965, issued by respondent no.3/ National Insurance Company Limited. Shri. Gulshan Kumar Goel was hospitalized on 30.06.2020 at Fortis Hospital/ respondent no.4, having contracted COVID-19, and expired on 07.07.2020. 3. It is alleged that respondent no.3 failed to honour the full claim under the policy, reimbursing only Rs.1,31,117/- out of the total sum insured of Rs.5,00,000. Petitioner no.1 claims to have paid Rs.51,500/- between 30.06.2020 and 03.07.2020, and Rs.5,37,703/- on 08.07.2020 to respondent no.4. A refund of Rs.1,95,295/- was made by respondent no.4 to the bank account of the brother of the deceased, allegedly representing excess charges collected at the time of release of the deceased’s body. 4. Thereafter, petitioner no.1 addressed a representation dated 21.12.2020 to respondent no.3, which was replied to vide letter dated This is a digitally signed order. The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 24/09/2025 at 13:08:27

31.12.2020, wherein respondent no.3 denied further liability and relied upon Circular dated 20.06.2020 issued by respondent no.1 prescribing rates for COVID-19 treatment. 5. A detailed order dated 16.09.2025 has been passed by this Court in W.P.(C) 5004/2022, wherein it has been held that the Circular dated 20.06.2020 issued by respondent no.1/ Government of NCT of Delhi cannot be construed as affecting the entitlement of policyholders under insurance policies issued by Insurance Companies. 6. In the present case, the maximum coverage afforded to the petitioners in terms of clause 2 (a) of the insurance policy, was to the tune of Rs.2.5 Lakhs. The same provides as under: “Coverage 2.A Room charges subject to 1% of sum insured per day and Intensive care unit charges subject to 2% of sum insured per day (including nursing care, RMO charges, IV fluids / blood transfusion / injection administration charges). 2.B Surgeon, anaesthetist, medical practitioner, consultants and specialist fees. 2.C Anaesthesia, blood, oxygen, operation theatre charges, any disposable surgical appliances subject to maximum of 10% of the sum insured, medicines and drugs, diagnostic materials and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of stent and implants. Sublimit (a) Total expenses incurred for any one illness is limited to 50% of sum insured. (b) Hospitalization expenses of person donating an organ during the course of organ transplant will also be payable subject to the sub limits applicable for any one illness within the sum insured. (c) Sub limit mentioned in 2.A and 2.C above shall not apply in a preferred provider network (PPN) for certain procedures.” 7. The order dated 25.08.2025, passed by this Court, in the present This is a digitally signed order. The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 24/09/2025 at 13:08:27 proceedings, recorded 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.” 8. In light of the fair stand taken by Mr. Pankaj Seth, learned counsel for the Insurance Company, the maximum amount to which the petitioners are entitled, has already been released. 9. As such, no further orders are required to be passed in the present petition; the same is, accordingly, disposed of. Pending application also stands disposed of. SACHIN DATTA, J SEPTEMBER 16, 2025/r