Miffed court in Gujarat teaches insurer basics of Covid

SURAT/VADODARA: A private insurance company curtly got some basic lessons in novel coronavirus infection from the consumer court which was miffed at the reasons it submitted for rejecting the mediclaim of a Covid-19 patient.
Vadodara District Consumer Disputes Redressal Forum literally turned a tutor, explaining to the insurer what coronavirus was, how it spreads among humans, its common symptoms and how quickly a patient’s oxygen level can dip, resulting in a medical emergency.
The case pertains to Paresh Patel, a resident of Jambuva Road in the city, whose treatment expenses of Rs 76,000 after he was hospitalized in September last year. The insurer – Universal Sompo General Insurance Company Ltd - had turned down the claim on the grounds that Patel’s vitals were stable and he did not have any respiratory complaints at the time of admission. Justifying its action, the company said that Patel’s hospitalization was only for monitoring purposes. Patel was admitted to a hospital in Maneja and later referred to Bhailal Amin General Hospital.
When these reasons were submitted during the hearing, the court expressed surprise and asked how the insurance company could conclude without a medical expert’s opinion that Patel was admitted only for monitoring purposes.
“There is no wisdom in the actions of the opponent (insurance company) while rejecting the claim of the complainant (Patel) and it smacks utter violation of principles of Consumer Protection Act,” the judgement read.
It also asked who will be held responsible if Covid-infected patients are not admitted to hospital and something happens to them. “By merely relying upon conjecture is baseless and therefore the officer of the insurance company has shown irresponsible behaviour towards society,” the court said.
The court then went on to explain what corona virus is. It also went on to state that there is no ‘licensed medication’ to cure Covid-19. But if patients are admitted to the hospital, the hospital staff takes care of them, monitors all vitals and also watches for any developing problems, the court stated in the judgement.
The forum presided by I C Shah asked the insurance company to pay the entire treatment expense of Rs 76,000 to Patel along with 7% interest and Rs 20,000 as compensation.