A Bengaluru consumer court has ruled that delays in paperwork by a treating hospital cannot be used as a valid reason to deny a genuine health insurance claim. The court directed a private insurance company to reimburse about Rs. 2.6 lakh, along with interest and compensation for mental agony, to the mother of a patient treated at a private hospital. The case arose after the patient was admitted to a private hospital on July 4, 2023, following a road accident and underwent treatment for facial fractures.
Although the family was covered under a group health insurance policy with a sum insured of Rs. 5 lakh, the cashless claim was denied because the hospital informed the insurer late about the admission. As a result, the patient’s mother had to pay the treatment expenses out of pocket and later applied for reimbursement. The insurer rejected the reimbursement claim, citing billing and…
