Hypertension, diabetes no ground to refuse Covid-19 insurance cover: Visakhapatnam consumer panel

Visakhapatnam: Visakhapatnam District Consumer Disputes Redressal Commission has ruled that hypertension and diabetes are not diseases and cannot be ground to deny medical insurance for Covid-19 treatment. The commission chided the private insurance company for denying a patient a rightful claim for treatment.

The commission ordered the insurance firm to pay the petitioner, the insurance sum of Rs1.89 lakh and compensation of Rs20,000 for agony caused besides costs of Rs5,000. Rahimunnisa Begum, a Member of the commission, asked the insurance companies not to play foul with the sentiments of the public at large by luring them with "false promises of care, support, and indemnification". She said at the time of claim settlement they raise their hands which amounts to unfair trade practices.

The Apex Court has observed that conditions like diabetes and hypertension are not diseases but common physical disorders and is no ground to deny rightful insurance money to patents

Veluvarthy Venkata Rao, a resident of Visalakshi Nagar in Vizag city had purchased an insurance policy (for a sum assured of Rs.5,00,000) from Manipalcigna Health Insurance Company Limited (formerly known as Cigna TTK – Health Insurance Company Limited) by paying Rs12,661 on January 31, 2019. He renewed the policy for one more year (valid till January 1, 2021).

In October 2020, he was diagnosed with Covid-19 and admitted to the insurance company-sponsored Medicover Hospital at Health City, Arilova in Vizag city on October 6. He underwent treatment as an inpatient from October 6, 2020, to October 12, 2020. His treatment at the hospital cost him close to Rs1.9 lakh. Since Rao purchased the insurance policy, he approached the company and presented the medical bills hoping for a refund of Rs1.89 lakh. To his shock, the insurance company rejected his claim stating that he had pre-existing ailments and Covid-19 which were not disclosed in the proposal form.

The insurance company claimed that Rao has had a history of diabetes and hypertension for the past 10 years. Rao approached district consumer disputes redressal commission-I in Visakhapatnam against the insurance company for unfair trade practices.

The commission observed that the Insurance Company allocated policy to the customers of Andhra Bank for the only reason that policy will help to meet any exigency. The Complainant paid the premiums and got renewed the policy. The commission said Covid-19 is a global pandemic which is an unprecedented and unwarranted scenario for the human world. The allegations of the Opposite party regarding suppression of pre-existing diseases of diabetes and hypertension since 10 years before issuing health policy "has no nexus to 'Covid-19' ".

The commission directed the insurance company to pay the medical claim of Rs1.9 lakh and Rs 20,000 as compensation to the complainant Rao. The commission asked the company to pay Rs 5,000 as legal costs to Veluvarthy Venkata Rao's wife Veluvarthy Vijaya, who was admitted to hospital for Covid-19 and the insurance company rejected the claim on the grounds of hypertension and diabetes.