KOCHI: The central government will intervene to prevent insurance companies from denying benefits to policyholders and paying low amounts for flimsy reasons.As a first step, the Insurance Regulatory and Development Authority (IRDA) and the Union Ministry of Consumer Affairs have decided to organize mediclaim adalats. Officials estimate that the subversion takes place mostly in medical claims.

The central authorities made this clear at a workshop organized in Ernakulam for the members of the Consumer Disputes Redressal Commission. The members of the Consumer Disputes Redressal Forum demanded that the medical claim provisions should also be changed in line with the development of treatment technologies.The Ernakulam District Consumer Commission ordered yesterday that the provision of insurance cover only if the patient stays in the hospital for 24 hours is a violation of the consumer's rights.

The order of the commission is that the treatment which can be completed in less time with the help of modern technology is also eligible for insurance cover. The order was based on the complaint that the medical claim was denied for the eye surgery of John Milton, a resident of Maradu.

Denial in Covid too

The Consumer Disputes Redressal Commissions have received many complaints about the rejection of insurance claims of deceased persons during the COVID-19 period. The denial is based on the argument that the cause of death was not COVID-19. Many complaints have been received that even though the doctors have given a certificate that the cause of the patient's death is COVID-19, the claim has been denied.

There are indications that companies are giving special benefits and packages to officials who reject more claims. When a benefit is given to one, it is denied to many others who have received the same treatment. The same company is discriminating in this way is also alleged that companies are making claims about conditions and terms that were not there when taking the policy. It is alleged that many people get only one-third or less of what they claim.