The Indian Express ·
Covid treatment claim rejected over 15-bed rule, Delhi man wins Rs 2 lakh from insurer
According to the insurer, the hospital had only 10 beds and hence did not meet the applicable 15-bed requirement for Covid treatment facilities, as per the policy clause.
A Delhi consumer commission has ordered an insurer to pay Rs 1.85 lakh to a Covid-19 patient whose health insurance claim was rejected because the hospital was allegedly recorded as having fewer than the 15 beds required under its policy. The commission held the claim could not be rejected for that reason alone, especially considering the Covid-19 regulatory framework that was in force when he was treated, and awarded another Rs 20,000 as compensation.
The District Consumer Disputes Redressal Commission-I (North Delhi) president Divya Jyoti Jaipuriar and members Harpreet Kaur Charya and Ashwani Kumar Mehta were hearing a complaint filed by Jamna Prasad against a government-owned public sector general insurance company and a private, non-government third-party administrator (TPA) over rejection of his mediclaim.
“The rejection of the claim by OPs on the flimsy ground that the treating hospital was not having 15 beds does not hold any ground,” the commission said on September 9, setting aside the rejection and holding the two opposite parties (insurer and TPA) jointly and severally liable for deficiency in service.
