On April 29, 53-year-old Santosh Kumar Pandey, a cancer patient and sole breadwinner for his family, moved the Delhi High Court after his health insurance claim was rejected, according to The Indian Express.
Seeing how much this ruling means for his survival, the judges wasted no time. They asked both Care Health Insurance and the Irdai to reply in writing about why Mr. Pandey’s coverage was refused. By fixing the next hearing for May 14, they set a firm schedule
On April 29, 53-year-old Santosh Kumar Pandey, a cancer patient and sole breadwinner for his family, moved the Delhi High Court after his health insurance claim was rejected, according to The Indian Express.
Diagnosed with advanced oral cancer, Pandey had taken his case not only against his insurer, Care Health Insurance, but also against the sector regulator, the Insurance Regulatory and Development Authority of India (Irdai).
Pandey filed a petition in which he accused Care Health of "illegally and arbitrarily" denying his claim worth over Rs 20.8 lakh, despite having a valid policy and a clean medical history. His lawyers argued that the insurer rejected the claim on the basis that Pandey was a tobacco user — a claim they say is unfounded. While he had no prior history of tobacco consumption, Pandey had to bear the burden of expensive treatment, including tracheostomy surgery and 35 cycles of chemotherapy. So far, he has only been able to undergo four.
The case took a serious turn on April 29 afternoon, while Pandey was at the Rajiv Gandhi Cancer Institute and Research Centre in Delhi for a dressing change. On the same day, the Delhi High Court strongly criticised the insurer for seeking more time to respond. Justice Sachin Datta, hearing the case, remarked:
“A person is dying, and you want time to file a reply? Ask the (Managing) Director to be in court next time.”
The court has now directed Care Health’s Managing Director, Atul Gulati, to appear in person on May 14, and has sought responses from both the insurance company and Irdai.
In his petition, Pandey has also asked the court to instruct Irdai to issue clearer, more robust guidelines for processing cashless medical claims, especially in urgent and life-threatening cases. In addition to the insurance amount, Pandey has also sought Rs 10 lakh in compensation for the mental distress and harassment caused by the claim denial.
For many policyholders, this case underscores a troubling question: What good is health insurance if it fails you when you need it most?
Pandey’s 23-year-old daughter, Shriyanshi, told The Indian Express that her father had lost a significant amount of weight, from 92 kg to 56 kg, within just a month. She said he was scheduled to be admitted on May 6 for immunotherapy, for which he had been prescribed a 200 mg dose. According to her, 100 mg of the medicine costs Rs 1.9 lakh. She also mentioned that he was currently on a semi-solid and liquid diet.