Delhi’s State Consumer Commission set aside a mediclaim reimbursement order after the claimant failed to rebut an insurance investigator’s findings.
The panel said the policyholder did not adequately challenge documentary evidence gathered by the insurer during the hospitalization review.
Indian mediclaim disputes often turn on whether investigators’ site visits and clinical summaries are answered with countervailing expert material.
The reversal restores the company’s denial position unless the claimant files a further appeal with new proof.
Consumer advocates urged policyholders to respond point-by-point when investigators allege non-disclosure or inflated billing.
Created by Ayen Stabel.
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Sources:
https://www.livelaw.in/