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Friday, October 22, 2021

CERC mediates, Covid victim’s family gets Rs 3.3 lakh in mediclaim

Failing to see any results after several visits to the hospital and the insurance company, Rana approached CERC to help him get the dues.

By: Express News Service | Ahmedabad |
Updated: October 2, 2021 3:14:53 am
A BMC health worker collects swab samples for Covid-19 test. (Express photo by Ganesh Shirsekar)

A Covid-19 victim’s family has won a claim worth Rs 3.3 lakh against a medical insurance company at the pre-litigation stage after mediation from the Consumer Education and Research Centre (CERC). Kamlesh Rana (name changed to protect identity) was finding it difficult get a medical insurance reimbursement after losing his father to Covid-19. According to CERC, Rana’s father was admitted in a popular private hospital in Ahmedabad for Covid-19 treatment. He was in the hospital for 10 days before he succumbed to the infection.

“When Kamlesh moved a claim with The Oriental Insurance Company Limited for reimbursement, the firm kept raising several queries. Kamlesh provided all the required details but still the insurance company asked for a break-up of the hospital Covid package rate. The hospital said it was following the package rate prescribed by the Ahmedabad Municipal Corporation and so, it was not feasible for them to provide a break-up of the rate,” said Girish Shah, head of complaints department, CERC.

Failing to see any results after several visits to the hospital and the insurance company, Rana approached CERC to help him get the dues. The centre contacted the insurance company and the hospital and tried to persuade them to resolve the matter amicably. The issue was resolved within a month as Rana received Rs 3,30,000 from the insurance firm as final settlement amount.

“It is rare that insurance cases are resolved in the pre-litigation stage and CERC has time and again helped consumers get their mediclaim amount without having to go to consumer courts,” Shah said.

“The new Consumer Protection Act 2019 is designed to be consumer-friendly to provide speedier redress. Consumers are advised to approach consumer organisations or even approach consumer courts directly, when insurance companies or regulators fail to respond in a fair manner,” he explained.



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