COVID claim denied, Health insurance company ordered to pay Rs 1.6 lakh

Meerut: Granting relief to a policyholder whose wife's health insurance claim was denied following her Covid-19 treatment at a private hospital, with the insurer citing non-disclosure of a pre-existing condition, the District Consumer Disputes Redressal Commission, Hapur, recently directed Star Health and Allied Insurance Co Ltd to pay Rs 1.6 lakh compensation towards the hospital expenses. 

While considering the complaint, the commission bench opined that the policyholder's wife was wrongfully denied a COVID claim and therefore directed the medical insurance company to comply with the order within 45 days, failing which a 6% annual penalty interest will apply.

The case dates back to 2020, when the complainant, a resident of Radhapuri, Hapur, admitted his wife to a private hospital in Ghaziabad with Covid-19 on September 16. She had undergone four days of treatment and was discharged on September 20. The medical bill exceeded Rs 2 lakh.

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Since both the complainant and his wife were covered under the Super Surplus Floater Revised Mediclaim Policy worth Rs 15 lakh purchased from Star Health and Allied Insurance Co Ltd, he submitted the required documents, including bills and prescriptions, to claim the expenses. The policy was valid from July 20, 2020, to July 19, 2021.