Summary of this article
Consumer forum ordered insurer to pay ₹1 lakh COVID-19 hospitalisation claim.
Ruling stressed only treating doctors can decide if hospitalisation is necessary.
Policyholders can challenge unfair insurance claim rejections through legal remedies.
In a relief for a Noida resident, the District Consumer Disputes Redressal Forum has directed an insurance company to pay Rs one lakh towards a hospital bill that was initially denied, according to a recent news report by the Times of India. The man had been admitted during the COVID-19 pandemic, but his claim was turned down on technical grounds.
Hospitalisation During Covid
The complainant, who held a valid health insurance policy, had been admitted to a city hospital after testing positive for COVID-19. His treatment ran up a bill of over Rs one lakh. When he filed a claim, the insurer rejected it, citing reasons the forum later found to be unjustified. The reason given was that the hospitalisation was not necessary, and the condition could have been treated at home.
1 August 2025
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Forum’s View On Rejection
The forum heard both sides and then ruled that the insurer was deficient in its service due to the rejection. They were of the view that only a treating doctor and not the insurance company has the right to decide whether a patient needs to be hospitalised or not.
So, it ordered the insurance company to settle the claim amount of Rs 1 lakh plus the applicable interest. The forum also awarded a small amount as compensation for the mental harassment caused to the policyholder.
What This Means For Policyholders
The case demonstrates that policyholders can challenge an insurance company’s decision if they believe it to be unfair. In this instance, the forum looked at the facts and found that the insurer had no valid reason to deny the claim.
In this instance, the forum looked at the facts and found that the insurer. As long as the insured has all the proper documentation in place and has made a declaration of pre-existing diseases, they have a strong chance of getting justice. So they should approach the ombudsman, and if still not resolved, they should approach a consumer forum.
Rising Disputes Over Covid Claims
Since the pandemic, there have been several complaints of COVID-related insurance claims being rejected. Consumer rights experts say policyholders should read their policy terms carefully and not hesitate to seek legal remedy if a claim is wrongly denied. The law gives consumers the option to approach district forums, state commissions, or even the national commission, depending on the amount involved.
