From examining all the facts of your query I want to say that-
These cases are very common in various Courts of India and Supreme Court of India. I can understand your concern in this regard. This is a serious issue nowadays. Many people call me from various places of India for this purpose. There are already many cases against Hdfc Ergo General Insurance Co Ltd in various consumer forums, High Courts and Supreme Court.
These uncertainties affect patients who have bought, or want to buy, health insurance to protect themselves from high-priced Covid-19 treatment. Besides regulation by government agencies like the IRDAI, customers have approached various courts to seek regulation of Covid-19 treatment prices at private hospitals and complaining about non-reimbursement of claims by insurance companies.
In August 2020, a Supreme Court bench looking into a petition on this matter chastised insurance companies: “When there's a pandemic, insurance companies can't keep their hands off.” “It is submitted that if such inflated billing by the private hospitals can become a cause of concern for the insurance industry, what will be the plight of a common man who neither has a fat wallet nor an insurance cover to reimburse, in case, he requires hospitalisation in a private hospital (sic),” says this ongoing petition at the Supreme Court. The petition pointed out that due to the lockdown-led economic downturn, many patients do not have ready cash to pay hospitals and thus need insurance companies to come through on cashless claims. It asked the court to direct insurance companies to settle all claims at government capped prices. The case is still ongoing in the Supreme Court.
Now, to take legal action you can file a complaint with Insurance Regulatory and Development Authority (IRDA) set up as autonomous body under the IRDA Act, 1999. It protects the interests of policyholders, to regulate, promote and ensure orderly growth of the insurance industry and for matters connected therewith or incidental thereto. You can file the complaint online.
You can also send a legal notice through good Advocate to build pressure on them. A legal notice is, therefore, a formal communication to a person or an entity, informing the other party of your intention to undertake legal proceedings against them. This notice, when sent, conveys your intention before the legal proceedings and thus, makes the party aware of your grievance. Many times, a legal notice served will bring the other party on heels, and the problem can get resolved out of court too, with fruitful discussions on both sides. And, if the other party is still not heeding to the grievance, one can always start the court proceedings after a particular interval, as stated by the law. Although a legal notice can serve as a purpose of negotiations between the parties and save time, effort and money that are usually spent in court cases. Compensation for mental and physical agony can demanded by sending this legal notice.
You may contact my secretary to connect with me for clarification.
Advocate on Record & Amicus Curiae,
Supreme Court of India