Act Strictly Against Insurance Firms, Consumer Court Tells IRDA

| Updated: September 28, 2022 3:44 pm

In some way or the other, Covid-19 continues to have a stranglehold on our lives. The number of cases may have dropped, but Covid-19 insurance policyholders are having a harrowing time in getting their claims approved.

Finally, the consumer court in Vadodara has intervened. The court has recommended that the Insurance Regulatory and Development Authority (IDRA) take swift action against companies that reject Covid-19 insurance on false grounds.

The consumer forum in Vadodara responded to a complaint by a city resident whose claim was partly rejected by The Oriental Insurance Company Ltd. Apparently, the insurance firm cited civic body guidelines on hospital bills as the reason.

The complainant, Pal, contracted pneumonia last year, following an initial Covid-19 infection. She filed a claim of Rs 4.63 lakh for treatment – she was hospitalised for three weeks – but the company reportedly accepted only part of the claim. The insurance firm claimed that Pal wasn’t eligible to get Rs 1.04 lakh, according to the policy rules.

The insurer’s advocate said that they rejected part of the claim, citing the Vadodara Municipal Corporation’s (VMC) guidelines on treatment packages.

Pal’s advocate Zeeshan Sheikh was quoted as saying, “The firm didn’t mention the policy clause under which it rejected the part claim. They just mentioned the VMC notification. If the hospital charges more money than the fixed ceiling rate, then it is an issue between the civic body and the hospital. It doesn’t concern the insured person.”

The court said, “IRDA’s senior officials should take note of it (such instances) and act strictly against the insurance firms flouting the guidelines.”

The court has ordered the insurance company to pay Rs 1.04 lakh with 9% to Pal from the date of filing the claim. Furthermore, the court directed that the insurance firm pay Rs 10,000 towards mental harassment and an equal amount as a legal expenditure.

Also Read: State Consumer Commission Strikes Down Claim of Accidental Insurance, Says Murder Was Pre-Planned

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