After three years of fight seeking justice, a Kerala man has successfully won compensation from Future Generali, a major corporate health insurance company which sold him a Corona Rakshak Policy promising hospitalisation expense coverage for Covid but denied it when he got admitted with Covid-19 infection.
The Ernakulam District Consumer Disputes Redressal Commission directed Future Generali India Insurance Company Ltd to pay compensation of Rs 1.6 lakh after Kochi native Ajaychand V approached the Commission with a petition that the company denied his claim though he had specifically purchased a Corona Rakshak Policy from the company. As per the details, Ajay Chand took the Corona Rakshak Policy from Future Generali India Insurance Company Limited on August 4, 2020 for himself and his mother that offered hospitalisation coverage of Rs 1.5 lakh for Covid.
On December 7, 2020, he was admitted as an inpatient to Amrita Institute of Medical Sciences and Research Centre (AIMS) after he tested positive for Covid-19. He incurred Rs 54,982 towards the hospital expense for the treatment of Covid-19. As he was entitled to an insurance amount under the policy, he submitted a claim on January 7, 2021, enclosing six documents including the discharge summary issued by AIMS. However, on March 18, 2021, he received a letter from the insurance company rejecting his claim on the grounds that the patient received all medication in oral form and was hospitalised mainly for investigation, evaluation, and supportive treatment purposes only. Hospitalisation means admission in a hospital designated for Covid-19 treatment by the Government for a minimum period of 72 consecutive ‘Inpatient care’ hours.
Aggrieved by the denial letter, Ajaychand decided to fight a case against Future Generali India Insurance Company Limited before the consumer court, submitting that as per the policy terms, the company was liable to honour the insurance claim because he was admitted to the hospital from December 7, 2020, to December 12, 2020, and treated continuously for more than 72 hours.
Based on the evidence submitted by Ajaychand, the commission led by its president D B Binu, members V Ramachandran and Sreevidhia T N directed Future Generali to pay the insurance claim amount of Rs 1,50,000, Rs 10,000 as compensation, and Rs 5,000 as cost of the proceedings to the complainant.
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