Insurance firm directed to pay compensation for repudiating claim related to COVID treatment in Mangaluru

The complainant had purchased a total family floater policy from the insurance firm in October 2020 under which the sum assured was ₹5 lakh

Updated - May 20, 2024 01:17 pm IST

Published - May 19, 2024 09:00 pm IST - MANGALURU

A file photo of a COVID-19 ICU ward. The complainant and his wife had been hospitalised for Covid.

A file photo of a COVID-19 ICU ward. The complainant and his wife had been hospitalised for Covid. | Photo Credit: Jothi Ramalingam B.

Dakshina Kannada District Consumer Disputes Redressal Commission has directed Future Generali India Insurance Company Limited to pay Vishwas Hegde and his wife Suhani Hegde ₹65,250 and ₹13,444 respectively for repudiating the claim of the two relating to COVID-19 treatment.

The 35-year-old Vishwas Hegde, a resident of Kalenja village of Belthangady taluk, purchased a health total family floater policy from the insurance firm in October 2020 under which the sum assured was ₹5 lakh. He paid annual premium for the period between October 9, 2020 and October 8, 2021.

On July 28, 2021, Mr. Hegde approached doctor Muralidhar Yadiyala following a cold. After the COVID-19 test, Mr. Hegde tested positive for COVID-19 on July 31, 2021, and he was advised home isolation. As he developed desaturation and panicking at home, Mr. Hegde was admitted to Vijaya Clinic on August 5, 2021. Suhani Hegde too tested positive for COVID-19 and she was admitted to the Clinic on August 6, 2021. Following their discharge on August 9, 2021, and on August 10, 2021, respectively, Mr. Hegde submitted a claim of ₹65,250 to the insurance firm.

When the insurance firm repudiated the claim, Mr. Hedge and his wife Ms. Suhani filed the complaint with the District Consumer Commission seeking compensation for deficiency in service.

Upholding the complaint, the District Commission said perusal of the discharge summary makes it clear that Mr. Hegde, a COVID-19 patient, was given further treatment for a cold, cough, and fever at the clinic. Ms. Hegde was treated at the clinic for being the direct contact of COVID-19 positive patient.

Holding that the insurance firm has committed deficiency in service, the commission comprising of president K. Prakasha and member H.G. Sharadamma, in their judgement on May 6, 2024, directed the insurance firm to pay Mr. Hegde ₹65,250 with 8% interest per annum from the date of complaint till realisation. It also directed the firm to pay Ms. Hegde ₹13,444 with 8% interest per annum. Further, the firm was asked to pay ₹15,000 to complainants as compensation and cost of litigation.

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