.2.5 Lakh Insurance Claim Approved for COVID-19 Hospitalization.2.5 Lakh Insurance Claim Approved for COVID-19 Hospitalization The Ernakulam District Consumer Disputes Redressal Commission has ordered Oriental Insurance Company to pay ₹2.5 lakh in insurance claims and ₹35,000 in compensation to Angamaly GM Jojo, who was denied coverage despite being hospitalized for over 72 hours after contracting COVID-19. Jojo and his wife had purchased the ‘Corona Rakshak’ policy, which promised a payout of ₹2.5 lakh for hospitalization of more than 72 hours due to the virus. However, the company rejected Jojo’s claim on technical grounds. After an investigation, the commission determined that Jojo was eligible for the claim as he met the hospitalization criteria. The panel highlighted that he should have received the benefit since he followed the company’s guidelines. The company argued that hospitalization was unnecessary and the treatment was only for symptom relief. However, the commission dismissed these claims, concluding that Jojo had been hospitalized for nearly seven days. The commission ordered the insurance company to settle Jojo’s claim of ₹2.5 lakh, pay ₹25,000 in compensation, and cover ₹10,000 in litigation costs within 45 days.
The Ernakulam District Consumer Disputes Redressal Commission has directed Oriental Insurance Company to pay an insurance claim of ₹2.5 lakh and compensation of ₹35,000 to a person who allegedly did not get insurance benefit despite being hospitalised for over 72 hours after contracting COVID-19.
The panel gave the order based on the complaint filed by Angamaly GM Jojo against the company. He and his wife had been using insurance offered by the company for the past 10 years. In 2020, they had bought the ‘Corona Rakshak’ policy (₹2.5 lakh each), according to a notice issued by the commission.
The company had assured that ₹2.5 lakh would be paid if the person was diagnosed with the viral infection and was admitted to the hospital for more than 72 hours. He was admitted to the hospital in April 2021 after the infection. However, the company rejected his claim citing technical reasons. Thereafter, the complainant and his wife filed a complaint with the Insurance Ombudsman. While the Ombudsman approved the claim of ₹2.5 lakh for his wife, it did not approve the claim he had filed.
The committee found that Mr. Jojo was hospitalized for nearly seven days. The panel comprising D.B. Binu, president and members V. Ramachandran and T.N. Sreevidya concluded that he was eligible for the claim as he had followed the guidelines prescribed by the company. The panel asked the company to pay the claim amount of ₹2.5 lakh, compensation of ₹25,000 and ₹10,000 towards litigation costs to the complainant within 45 days.
The company denied the claim, stating that hospitalization was not necessary and that the treatment was only intended for conservative management and symptom relief.
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