HC notice on insurance company for not paying full claim on Covid death

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The Delhi High Court has asked for the Delhi government’s and the Insurance Regulatory and Development Authority’s (IRDA) stand on a plea by a woman and her two minor children against an insurance company’s decision not to pay the entire insured amount after her husband died due to Covid-19.

The plea was filed by Sunita Goel and her two minor children who are residents of Delhi. As per the plea, the Covid victim Gulshan Kumar Goel (Sunita’s husband) held a mediclaim policy, Parivar Mediclaim Policy, of the insurance company and the sum insured, was Rs 5 lakh. Goel had contracted the coronavirus infection in the last week of June 2020 and was hospitalised days later on June 30 at Fortis Hospital, Shalimar Bagh, where he expired on July 7, 2020.

Justice Rekha Palli has issued a notice to the Delhi government, IRDA, the National Insurance Company Ltd, and Fortis Hospital at Shalimar Bagh, where the woman’s husband died during treatment last year.

The hospital had charged a bill of Rs 5.33 lakh, which was paid by the woman as the insurance company refused from paying the hospital bill to the extent of the sum insured. The hospital had refunded Rs 1.95 lakh from the bill on grounds that it was charged extra.

The petitioners have sought compensation of Rs 25 lakh from the insurance company and the hospital.

The family has sought direction from the insurance firm to reimburse the hospital bill amount, or the hospital refunds the total expense that was charged.

The petitioners have also asked IRDA to take strict action against the insurance firm for violating its guidelines so that no insurer may escape from their liability of making payment.

It also sought to direct the Delhi government to take strict legal action against the hospital for violating its June 2020 circular which prescribed maximum per day package rates for treatment of Covid-19 patients in private hospitals.