A Covid-19 casualty’s family has won a case worth Rs 3.3 lakh against a clinical insurance agency at the pre-case stage after intervention from the Consumer Education and Research Center (CERC). Kamlesh Rana (name changed to ensure personality) was thinking that it is hard to get a clinical protection repayment subsequent to losing his dad to Covid-19. As per CERC, Rana’s dad was admitted to a famous private medical clinic in Ahmedabad for Covid-19 therapy. He was in the clinic for 10 days before he surrendered to the disease.
“When Kamlesh moved a claim with The Oriental Insurance Company Limited for reimbursement, the firm kept raising several queries. Kamlesh provided all the required details but still the insurance company asked for a break-up of the hospital Covid package rate. The hospital said it was following the package rate prescribed by the Ahmedabad Municipal Corporation and so, it was not feasible for them to provide a break-up of the rate,” said Girish Shah, head of complaints department, CERC.
Failing to see any results after several visits to the hospital and the insurance company, Rana approached CERC to help him get the dues. The centre contacted the insurance company and the hospital and tried to persuade them to resolve the matter amicably. The issue was resolved within a month as Rana received Rs 3,30,000 from the insurance firm as final settlement amount.
“It is rare that insurance cases are resolved in the pre-litigation stage and CERC has time and again helped consumers get their mediclaim amount without having to go to consumer courts,” Shah said.
“The new Consumer Protection Act 2019 is designed to be consumer-friendly to provide speedier redress. Consumers are advised to approach consumer organisations or even approach consumer courts directly, when insurance companies or regulators fail to respond in a fair manner,” he explained.
