AHMEDABAD: Lashing out at insurance companies for arbitrary and illogical rejection of Covid-19 claims despite the policy holder having a special insurance cover, the Gandhinagar District Consumer Redressal Commission said that the amount in such cases should be recovered from the erring officers of the companies.
The commission made the remark in a case involving one Pravinaben Patel, a resident of Sector 25, who had a special Corona Rakshak Policy of Rs 2.50 lakh from IFFCO Tokio General Insurance Co Ltd.
She fell ill in April 2021 and was treated for Covid-19 in a hospital in Pethapur near Gandhinagar. She incurred a bill of Rs 1.23 lakh and later submitted the claim only to be rejected on grounds that she had hypertension, which she had not disclosed while obtaining the policy.
When Patel dragged the insurer to the consumer commission, it observed that even the higher courts have held that if hypertension is not mentioned in proposal form, it cannot be treated as suppression of material fact. It said hypertension or diabetes can be controlled by regular medication.
The commission further said that insurance companies do not adhere to Insurance Regulatory and Development Authority (IRDA) circulars on Covid-19 and keep "eyes (out) as a bloodhound and not as a watchdog".
The commission also observed that it is the duty of government insurance companies to safeguard public money as its trustees, and distribute it according to the entitlements of the policy holders, but they take a myopic and hyper-technical view resulting in piling up of cases in consumer courts.
Directing the insurer to pay Rs 2.50 lakh insurance amount with Rs 15,000 extra towards compensation to the policy holder, the commission said, "Such type of money requires to be recovered from the pocket or salary of the erring officer who has decided to deny the claim, whimsically." The commission asked the companies to keep the observations in mind so that in future, the patients do not suffer.