Gujarat: Big decision of Gandhinagar Consumer Disputes Redressal Commission. Loktej Gujarat News

Gujarat: Big decision of Gandhinagar Consumer Disputes Redressal Commission.  Loktej Gujarat News

Reprimanded Oriental Insurance Company for denying compensation by deducting the insurance claim by treating the day care treatment of father and son, a Corona patient, as admitted in a home hospital, in violation of the IRDA circular. Gandhinagar Consumer Disputes Redressal Commission Chairman D.T. The bench comprising Soni and member Sandeep Pandya has given an important decision, which is a relief for the patients who were treated during the Corona period. In a historic decision, the Commission clearly said that in the emergency situation of the Corona period, the insurance company has shown an indifferent attitude in many cases. Not only this, since the IRDA circular dated 4-3-2020 is mandatory, the insurance company is bound to comply with it, although the respondent insurance company is also aware of this IRDA circular. It is the duty of the insurance company to follow the IRDA circular and maintain its dignity.

The Commission, in its order, said that this constitutes a very clear case of lapse in service to the policyholder and hence the insurance company is held liable. Despite clear instructions in the IRDAI circular that it should not be rejected without any review in case of Corona cases. Despite this, the insurance claims of Corona patients have been rejected by the insurance company. It is clear from the evidence and medical documents that the complainant father and son contracted Corona while paying the total claim to the insurance company. The Commission ordered the defaulting insurance company, Oriental Insurance Company, to pay the amount along with interest to the respondent.

Gandhinagar residents Jagdishbhai Trivedi and his son Kaushal Trivedi had filed a complaint with the Gandhinagar-State Commission challenging the arbitrary decision of the insurance company to reject the claim for day-care treatment during the Corona period. In which Consumer Protection, Consumer Satyagraha, Consumer Revolution President Suchitra Pal had tried to get the complainant’s son admitted to the hospital when he got corona during the Corona period. But at that time Corona emergency also arose, there was no space in the hospital.

Due to which, as per the advice of the doctors of Covid Care Group of Somes Hospital, 3-care treatment was taken from 11-4-2021 to 15-4-2021. During that time, the complainant father and son were covered under the Happy Family Floater Policy of Oriental Insurance Company. The treatment expenses of both father and son were Rs 72,953 and Rs 74,193 respectively. Therefore, both father and son presented their claim before the insurance company under the said policy. However, the insurance company rejected the claim of the complainant father-son in a completely illegal manner. What this means is that the IRDA circular and the mandatory provisions specified therein have been violated by the insurance company.


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