Consumer Forum asks HDFC-ERGO to pay Rs 5 lakh to COVID survivor

The insurer had denied the claim, saying that patient submitted a fake document
The policyholder had to spend Rs 4.08 lakh after catching COVID in 2021
The policyholder had to spend Rs 4.08 lakh after catching COVID in 2021

SHIVAMOGGA: The district consumer disputes redressal commission directed HDFC-ERGO General Insurance Co. Ltd to pay an insurance amount of Rs. 4.08 lakh plus interest and compensation to a doctor who had to undergo hospitalization after catching COVID three years ago.

Petitioner CD Raviraj, a BAMS doctor, obtained a health insurance policy from HDFC-ERGO General Insurance Co. Ltd in 2021 with a coverage of up to Rs 6 lakh.

The doctor caught COVID later in the year and was hospitalised for several days. The total treatment cost was Rs 4,08,564.

Subsequently, when the applicant sought reimbursement of medical expenses, the claim was denied saying he had created a fake document. The company also cancelled the insurance policy.

However, after going through the documents submitted by the parties and medical records, the consumer commission concluded that the insurer was at fault and committed a deficiency in service.

The commission directed the insurance company to reinstate the petitioner's policy within 45 days, and pay the insurance amount of Rs 4.08 lakh with an annual interest of 9%. It also asked the company to pay Rs 25,000 as compensation for mental agony, and Rs 10,000 towards litigation expenses.

The commission was led by President T Shivanna and comprised members Savita B Pattanashetty and B D Yogananda Bhandya.

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