The Central Mumbai District Consumer Dispute Redressal Commission has ordered New India Assurance Company to pay Rs 20,620 for rejecting a claim from a 78-year-old resident, Rajan Alimchandani, for home treatment expenses during the COVID-19 pandemic. The commission also ordered the company to pay Rs 25,000 for mental distress and Rs 5,000 for litigation costs.
Alimchandani tested positive for COVID-19 in August 2022 and his doctor decided against hospitalization, opting for home treatment instead. He submitted a claim to the insurance company for the expenses, but it was rejected on the grounds that there was no hospitalization. The company argued that the policy terms required a minimum of 24-hour hospitalization to qualify for benefits.
The commission found the insurance company at fault for rejecting the claim, citing that the treatment provided under a doctor’s supervision for COVID-19, even at home, warranted coverage. The commission held that the rejection of the claim constituted a deficiency in service and caused unnecessary mental distress to the complainant.
The commission orders the insurance company to pay the claim amount of Rs 20,620, Rs 25,000 for mental distress, and Rs 5,000 for litigation costs, holding the company accountable for its unfair practices. This decision sets a precedent for future cases and serves as a reminder to insurance companies that they must provide coverage for treatment costs, even if treatment is provided at home under a doctor’s supervision.