Chandigarh: Insurer rejects Covid mediclaim over non-hospitalisation, fined

Denying a Covid-19 patient’s medical claim on the grounds of non-hospitalisation has cost an insurance company dear. Holding Manipal Cigna Health Insurance Company Limited, Chandigarh, guilty of causing the patient mental agony and harassment, the District Consumer Disputes Redressal Commission, Chandigarh, had directed the firm to settle her ₹5,521 claim and also pay ₹10,000 as compensation, apart from ₹10,000 as litigation costs. The patient, Nidhi Gupta, a resident of Panchkula, had submitted that she had bought a ₹25 lakh Family Floater Mediclaim Insurance Policy from the company for her family, including herself, her husband and two minor sons, by paying premium of ₹35,636. However, the commission observed that the insurance company could not repudiate the claim on technical grounds, such as non-hospitalisation, especially when the situation in 2020 due to the Covid-19 pandemic was so serious that even beds in hospitals were not available and majority of the patients were advised to remain under home isolation. “Hence, it is safe to hold that the act of the insurance company in repudiating the genuine claim of the complainant certainly amounts to deficiency in service on their part and the present consumer complaint deserves to succeed,” the commission said, while directing the insurer to pay compensation to the patient and also settle the claim, along with interest at 9% per annum from the date of repudiation of claim, May 3, 2021, till its realisation.