Reimburse entire Covid bill: Court orders insurer

Vadodara: An insurance company cannot pass on the burden to an insured person if a Covid-designated hospital has violated terms of contract between the hospital and Vadodara Municipal Corporation (VMC).

A consumer court in the city on Friday made this observation while not only asking United Insurance Company Ltd to pay the entire treatment bill to a resident of Harni-Warasia Ring Road, who was infected with Covid-19, but also directing the civic body and state government’s health department to inquire and act against hospitals which charged more than the capped treatment rates set by VMC.

Alpa Fadia had approached Vadodara District Consumer Disputes Redressal Forum after the insurance company did not pay the claim amount of Rs 1.2 lakh for her husband Mayank’s Covid-19 treatment.

Mayank was admitted to a private Covid-designated hospital in April and had paid over Rs 2.2 lakh for the treatment. The couple had submitted a claim to the insurance company to reimburse the treatment expenses as Mayank was covered under the Corona Kavach policy.

But they were paid only a part of the bill amount by the insurance company as it cited VMC’s notification.

The notification had capped the ward rates at Rs 8

,500 for a day which would also include pathology and medicine charges.

During the hearing of the case, the couple’s lawyer argued that they are entitled to get the full amount as they had nothing to do with the VMC’s notification. It was also argued that if the insurance company believes that the hospital had charged more, then it should complain to the VMC against the hospital.

The consumer forum presided by I C Shah upheld the arguments and also noted that the insurance company is duty-bound to reimburse the full amount to the claimant as per the contract of insurance.

“If at all the insurance company feels that the hospital has charged an exorbitant amount as against the package charges fixed by the VMC then the insurance company should initiate appropriate legal proceedings against the hospital and should approach the authorities of VMC,” the court noted. The court directed the insurance company to pay the remaining amount to the couple with 9% interest and a compensation of Rs 10,000.