Consumer Commission orders compensation after insurance company refuses customer’s claim concerning hospitalization due to COVID-19

The Surat District Consumer Redressal Commission ordered an insurance company to pay compensation to a customer who had been hospitalized due to COVID-19 but had seen his claim rejected by the company itself.

The company had refused to pay the hospitalization’s bill invoking a clause of the policy which denied compensation in cases when hospitalization was not required. The customer therefore decided to sue the company asking for payment of hospital expenses and damages for moral harassment.

During the proceeding, the insurance company once again argued that the customer’s illness was not severe and therefore admission to the hospital was not needed. However, the Commission noted that the ultimate decision upon the necessity of hospital treatments rests on the doctors. Furthermore, the insurance company, when rejecting the claim, had completely ignored the CT Scan Report of the man, which indicated COVID-19 infection.

The company was therefore ordered to pay compensation, since the rejection of the customer’s claim was deemed unjustified and unjust.

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