CONSUMER EDUCATION AND RESEARCH

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Press Release
COVID patient recovers Rs 3.3 lakhs mediclaim from Oriental Insurance after
CERC mediation
30 September 2021
After recovering from serious Covid complications which led them to the hospital, several patients
fight another battle of recovering the money spent from their mediclaim company. Many
consumers have complained that Insurance companies are arbitrarily deducting claim amount or
even rejecting the claim on the basis of several unreasonable grounds.

Kamlesh Rana* faced a very difficult time in getting the medical insurance reimbursement after he
lost his father to Covid. He was finally able to get his claim amount of Rs. 3,30,000 with the
intervention of CERC mediation team. It is very 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.

Kamlesh’s father was admitted in a reputed hospital in Ahmedabad for Covid treatment. He was in
the hospital for 10 days after which unfortunately he passed away. When Kamlesh put a claim with
The Oriental Insurance Company Limited for reimbursement, the company 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 that it was following the package
rate prescribed by AMC and so it was not feasible for them to provide a break-up of the rate.

Kamlesh was tossed between the hospital and the insurance company for several days. He finally
decided to ask Consumer Education and Research Centre to help him get his rightful dues. CERC
contacted the insurance company as well as the hospital and tried to persuade them to resolve the
matter amicably. In less than a month, Kamlesh was elated that his mediclaim was passed and he
received Rs. 3,30,000 from The Oriental Insurance Company Limited as final settlement amount.

Girish Shah of CERC said, “We have seen a steady increase in consumer complaints against
insurance companies for rejection of their claims. The deductions in the claim amounts and
repudiating claims for various reasons is being seen in several cases. There is also lack of
transparency in claim processing. We have many cases which we have tried to resolve through
mediation. But we had to resort to legal recourse for some. Many consumers have even given up the
pursuit because they are tired of constant follow-ups and reminders. Our advice to consumers is,
never to give up. The new Consumer Protection Act 2019 is designed very consumer friendly, and is
designed to provide speedier redress. Consumers are advised to approach Consumer Organisations
like CERC, or even approach consumer courts directly, when insurance companies or regulators fail
to respond in a fair manner”

*Name changed

For more information, please contact Anusha Iyer 9825005612 or Girish Shah 8980234061