Insurance company directed to reimburse Rs 17 lakh to man

COIMBATORE: The district consumer redressal commission has directed a private insurance company to reimburse Rs 17 lakh in medical expenses to a customer who contracted Covid-19, followed by a heart attack and liver complications. The commission noted that the claim had been rejected without valid grounds, despite the submission of all necessary documents.

According to official sources, S Ranganathan of Kalveerampalayam in Coimbatore purchased an international travel insurance policy from the private insurer for the period from Dec 11, 2023, to June 6, 2024. He travelled to Singapore on Dec 12, 2023, and tested positive for Covid-19 on Dec 15.

He suffered a heart attack and other complications and was admitted to Sengkang General Hospital, Singapore, from Dec 15 to 23, incurring medical expenses amounting to SGD 27,523.93 (approximately Rs 17 lakh).

After returning to Coimbatore on Dec 24, 2023, he continued treatment in a private hospital, incurring additional medical expenses of Rs 75,100.

His son submitted the medical reports and final bills to the insurance company on Jan 3, 2024. Company officials verified the case in person on Jan 11. However, the claim was rejected on Jan 24 on the grounds of alleged non-disclosure of a pre-existing heart condition. Ranganathan, however, had no history of heart ailments, and the heart attack occurred only after contracting Covid-19. Supporting medical records and a certificate from the treating doctor were also submitted.

A complaint was then lodged with the insurance ombudsman, but the hearing was missed due to a missed email alert. The case was dismissed. A request for a re-hearing was also denied.

Subsequently, Ranganathan filed a petition with the Coimbatore district consumer redressal commission. In its order, commission president R Thangavel and members P Marimuthu and G Suguna directed the insurance company to reimburse the medical expenses of Rs 17 lakh. The company was also ordered to pay him Rs 10,000 as compensation for mental agony and Rs 5,000 towards the cost of the proceedings.


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