Consumer forum directs insurance firm to pay COVID treatment claim

November 05, 2023 06:43 pm | Updated 06:43 pm IST - KOCHI

The Ernakulam District Consumer Disputes Redressal Commission has directed Star Health and Allied Insurance Company to pay a complainant ₹1 lakh claimed towards COVID-19 treatment under its policy ‘Corona Rakshak’.

The commission also directed the company to pay ₹10,000 as compensation to the complainant, K.R. Prasad of Muvattupuzha, in addition to ₹10,000 towards litigation cost. According to the complainant, he was diagnosed with COVID-19 and admitted to a private hospital at Muvattupuzha from January 17 to 21 in 2021. He had to spend ₹2.3 lakh towards medical expenses. Policy-holders were entitled to benefits equal to 100% of the sum insured under the policy if they were diagnosed with COVID.-19 However, the insurance company refused to reimburse the money spent by him for his treatment. The company contended that the complainant’s medical records indicated stable vitals and the hospitalisation was for observation and monitoring rather than for treatment.

The commission found deficiency in service and unfair trade practice on the part of the opposite party. It added that the insurance policy ‘Corona Rakshak’ was specifically designed to provide coverage for COVID-19. The complainant had fulfilled the conditions laid down in the policy by being hospitalised for more than 72 hours due to COVID-19.

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