- DIMAPUR — The Kohima Bench of Gauhati High
Court has directed Future Generali India Insurance Co. Ltd. (FGI) to settle
pending health insurance claims under the Ayushman Bharat Pradhan Mantri Jan
Aarogya Yojana (AB-PMJAY) and the Chief Minister’s Health Insurance Scheme
(CMHIS) in Nagaland within four weeks.
- The order was passed during a hearing on Public Interest
Litigation (PIL) concerning delays in claim settlements that led to withdrawal
of services by private hospitals in the state since March 17, 2025.
- A division bench of Justice Kakheto Sema and Justice
Yarenjungla Longkumer issued the directive after noting that FGI had failed to
honour the timelines it committed to during a joint meeting on May 7, 2025. The
meeting, chaired by the Joint Secretary of the National Health Authority (NHA),
was attended by officials from IRDAI, DFS, the Nagaland State Health Agency
(SHA), and FGI.
- According to the meeting minutes submitted to the court, the
state had raised concerns about delayed claim payments for the policy year
between April 1, 2024 and March 31, 2025, which had led to the suspension of
services by private hospitals.
Also read: Nagaland Health Protection Society says Future Generali India’s allegations of fraud cause delays in claim settlements
- FGI had claimed that payments were held up due to suspicions
of fraudulent activity by certain empanelled hospitals. However, the NHA
emphasised that “FGI remains responsible for the actions of its empanelled TΡΑ
[third party administrator] and reiterated the urgency of releasing pending
claims.”
- During the meeting, FGI had committed to settling claims for
hospitals outside Nagaland and within the state (where no fraud was flagged) by
May 15, and for alleged fraudulent cases by May 30. The insurer had also agreed
to re-examine rejected cases and deploy a team to Nagaland to work with the
State Medical Committee and Nagaland Health Protection Society (NHPS) for final
resolution.
