Consumer Forum Orders Insurance Company To Reimburse Covid Treatment Claim

The Ernakulam District Consumer Disputes Redressal Commission has issued a directive to Star Health and Allied Insurance Company to disburse Rs 1 lakh to a complainant, KR Prasad from Muvattupuzha, in accordance with his claim for Covid-19 treatment under the 'Corona Rakshak' policy. In addition to the reimbursement, the commission has ordered the company to pay a compensation of Rs 10,000 to KR Prasad, as well as cover his litigation expenses of Rs 10,000.

KR Prasad lodged a complaint asserting that he had contracted Covid-19 and was admitted to a private hospital in Muvattupuzha from January 17 to 21, 2021. He incurred medical expenses amounting to Rs 2.3 lakh during this hospitalisation. 

The policy, 'Corona Rakshak,' entitled policyholders to receive benefits equal to 100 per cent of the sum insured if they were diagnosed with Covid-19. Nonetheless, the insurance company declined to reimburse his medical expenses, arguing that his medical records showed stable vitals and that his hospitalisation was primarily for observation and monitoring, rather than for active treatment.

The commission identified deficiencies in service and unfair trade practices on the part of the insurance company. It emphasised that the 'Corona Rakshak' policy was explicitly designed to provide coverage for Covid-19, and KR Prasad had met the policy's conditions by being hospitalised for more than 72 hours due to Covid-19.