High Court directs Future Generali to settle Nagaland health insurance claims within four weeks

Published on Jun 4, 2025

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.

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.
The court, however, observed that these commitments remain unfulfilled and directed FGI to “positively finalise the settlement of the claims as incorporated in the minutes of the meeting dated May 7, 2025, within four weeks from today, and file affidavit to that effect.”
The bench further clarified that “any issue/dispute with regard to the settlement of the claims shall be sorted out between the respondent no. 4 [Nagaland Health Protection Society] and the respondent no. 5 [FGI], without adversely affecting the genuine claims of the respondent no. 6 [Nagaland Private Doctors Association].”
The matter has been listed for the next hearing on July 16.