Ernakulam consumer panel asks insurance company to pay claim of ₹2.5 lakh to policy holder

The Ernakulam District Consumer Disputes Redressal Commission has directed Oriental Insurance Company to pay an insurance claim of ₹2.5 lakh and a compensation of ₹35,000 to a person, who was allegedly denied insurance payment despite being admitted to hospital for over 72 hours following COVID-19 infection.

The panel issued the order based on the complaint lodged by Jojo G.M. of Angamaly against the company. He and his wife were having insurance cover offered by the firm for the last 10 years. In 2020, they had purchased the ‘Corona Rakshak’ policy (₹2.5 lakh each), according to a communication issued by the commission.

The company had assured payment of ₹2.5 lakh, if the person was diagnosed with the viral infection and admitted to hospital for over 72 hours. He was admitted to hospital following the infection in April, 2021. However, the firm rejected his claim citing technical reasons. Thereafter, the complainant along with his wife submitted a complaint before the Insurance Ombudsman. Though the Ombudsman sanctioned the ₹2.5 lakh claim for his wife, it did not approve the claim made by him.

The commission found that Mr. Jojo was admitted in hospital for nearly seven days. The panel comprising D.B. Binu, president, and members V. Ramachandran and T.N. Sreevidya found that he was eligible for the claim as he had adhered to the guidelines prescribed by the company. The panel asked the company to pay the claim of ₹2.5 lakh, a compensation of ₹25,000, and ₹10,000 towards court expenses to the complainant within 45 days.

The company had denied the claim saying that hospitalisation was not required, and the treatment was only for conservative management and symptomatic relief.