Delhi’s State Consumer Commission set aside a lower forum order that had directed mediclaim reimbursement, ruling the claimant failed to rebut findings in the insurance company’s investigator report.
The insurer had documented alleged discrepancies between hospital bills and policy coverage terms, conclusions the complainant did not counter with independent medical billing analysis.
The reversal highlights that favorable district-level consumer orders remain vulnerable on appeal when record evidence favors the insurer and the insured offers no substantive reply.
Health insurance ombudsmen said policyholders should respond point-by-point to investigator dossiers rather than relying on generalized claims of good faith.
Created by Ayen Stabel.
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Sources:
https://www.livelaw.in/