Ranga Reddy: Heritage Insurance, New India Assurance asked to pay Rs 1.96L for unfair policy settlement
It also directed to pay a compensation of Rs 15,000 for causing inconvenience and mental agony, and Rs 5,000 towards litigation costs
By Sistla Dakshina Murthy Published on 4 Sep 2024 6:30 AM GMT
Hyderabad: District Consumer Disputes Redressal Commission, Ranga Reddy has directed Heritage Health Insurance TPA Pvt. Ltd and New India Assurance Co. Ltd to pay Rs 1,75,939 remaining policy amount with 9 percent interest to a government employee.
It also directed to pay a compensation of Rs 15,000 for causing inconvenience and mental agony, and Rs 5,000 towards litigation costs to the complainant.
Case details
Harish Kumar Yalagandala, a resident of Tirumalagiri, Secunderabad obtained a Corona Kavach Policy from Heritage Health Insurance TPA Pvt. Ltd and New India Assurance Co. Ltd. It is effective from July 30, 2020, to April 25, 2021. After the waiting period from July 15, 2020, to July 29, 2020, Harish Kumar and his wife were infected with coronavirus on July 31, 2020.
The duo were admitted to Orange Hospital, LB Nagar Hyderabad, and Harish Kumar was treated as an inpatient from August 06, 2020, to August 12, 2020. In all, he spent Rs 4,10,000 on treatment in the hospital and claimed the same from the opposite parties.
After six months on February 23, 2021, the opposite parties accepted the amount payable to the complainant to the tune of Rs 2,34,061 and rejected the remaining amount of Rs 1,75,939. As such Harish Kumar approached the Commission for redressal. Notices were served to Heritage Health Insurance TPA Pvt. Ltd but it failed to appear before the Commission.
On April 22, 2022, the opposite party number one was set exparte. New India Assurance Co. Ltd filed a written version by denying the allegations made in the complaint. The opposite parties contended that Heritage Health Insurance TPA Pvt. Ltd evaluated the claim for an amount of Rs 2,34,061 and as such the same was paid to the complainant on February 23, 2021.
New India Assurance Co. Ltd further contended that as per condition II of IRDA notification dated March 04, 2020, āThe costs of admissible medical expenses during treatment during the quarantine period shall be settled by the applicable terms and conditions of the policy contract and extent regulatory frameworkā.
The opposite parties compiled the same and there would be no grievance at all and prayed to dismiss the complaint as there is no deficiency on their part.
After hearing the arguments, the Court noted that as mentioned by the opposite parties in the written version, the payable amount was shown as Rs 3,17,106 but they allowed only the claim to an extent of Rs 2,34,061 by rejecting the remaining amount of Rs.1,75,939.
The Court pointed out that as per the Corona Kavach Policy, there is no mention of any terms and conditions about the exclusion of the amount. Admittedly, the policy contains no exclusion clause and does not mention any such exclusion clause. The opposite parties under the guise of IRDA notification allowed the claim of the complainant partially and the deduction of the remaining amount by them without any such exclusion clause in the terms and conditions of the policy is unfair and amounts to a deficiency of service on the part of the Opposite Parties.
Hence the complaint is entitled to relief. It includes paying the remaining amount of Rs 1,75,939 due under the policy to the complainant together with 9 percent, compensation of Rs 15,000, and Rs 5,000 towards litigation costs.
