KOCHI: The District Consumer Disputes Redressal Commission in Ernakulam has ordered an insurance company to pay Rs 1.2 lakh to a person whose claim was denied citing a lack of documents.
Star Health and Allied Insurance Co Ltd has been asked to pay the sum to K R Prasad, a Muvattupuzha resident who had taken its ‘Covid Rakshak’ policy in 2020 with Rs 1 lakh assured. The policy entitled him to a lump sum benefit equal to 100% of the sum insured if he was diagnosed with Covid and required hospitalisation for at least 72 hours.
Prasad contracted Covid and was hospitalised in Muvattupuzha from January 17 to January 21, 2021, incurring Rs 2,35,273 in treatment expenses. His reimbursement claim was rejected on April 13, 20-21, citing his failure to provide consultation papers, investigation reports, and treatment details related to bronchial asthma. After the Insurance Ombudsman dismissed his application, Prasad approached the commission seeking Rs 1 lakh with interest from the date of the claim until its settlement and Rs 10,000 as compensation for the emotional distress and financial difficulties he faced due to unfair denial of his claim, besides legal costs.
The insurance company claimed Prasad concealed pre-existing medical conditions like bronchial asthma and hypertension, and that he was reluctant to submit the required documents for the claim, due to which his application was denied. Prasad argued that he could not provide treatment records for bronchial asthma as he had never underwent any prior treatment for the ailment.
The commission found the insurance firm’s actions deficient as the policy ‘Covid Rakshak’ was specifically designed to provide coverage for Covid-19. “The complainant fulfilled the conditions in the policy by being hospitalised for more than 72 hours due to Covid. The insurance company’s insistence on obtaining medical records of bronchial asthma, which is unrelated to the claim, is unjustified and amounts to unfair trade practice and deficiency in service,” the commission observed.