The Dakshina Kannada District Consumer Disputes Redressal Commission has instructed Future Generali India Insurance Company Limited to compensate Vishwas Hegde and his wife, Suhani Hegde, for denying their claims related to COVID-19 treatment. The commission ruled that the insurance firm must pay Vishwas Hegde ₹65,250 and Suhani Hegde ₹13,444.
Vishwas Hegde, a 35-year-old resident of Kalenja village in Belthangady taluk, purchased a family floater health policy from the insurance company in October 2020, with a sum assured of ₹5 lakh. He paid the annual premium for the coverage period from October 9, 2020, to October 8, 2021.
On July 28, 2021, Hegde sought medical attention from Dr. Muralidhar Yadiyala for a cold. He tested positive for COVID-19 on July 31, 2021, and was advised to isolate at home. However, as his condition worsened with desaturation and anxiety, he was admitted to Vijaya Clinic on August 5, 2021. Suhani Hegde also tested positive for COVID-19 and was admitted to the same clinic on August 6, 2021. Following their discharge on August 9 and August 10, 2021, respectively, Vishwas Hegde submitted a claim of ₹65,250 to the insurance company. The insurer repudiated the claim, prompting the Hegdes to file a complaint with the District Consumer Commission, alleging deficiency in service.
The District Commission reviewed the discharge summary, confirming that Vishwas Hegde, a COVID-19 patient, received treatment for cold, cough, and fever at the clinic. Suhani Hegde was treated as a direct contact of a COVID-19 positive patient.
The commission, comprising President K. Prakasha and member H.G. Sharadamma, found the insurance firm guilty of service deficiency. In its judgment dated May 6, 2024, the commission directed the insurance firm to pay Vishwas Hegde ₹65,250 with 8% interest per annum from the date of the complaint until realization. Additionally, the firm was ordered to pay Suhani Hegde ₹13,444 with 8% interest per annum. The commission also mandated the insurance company to pay ₹15,000 to the complainants as compensation for litigation costs.
