The Economic Times

Oriental Insurance rejects mediclaim saying hospitalisation was not necessary: Court says doctors, not insurers, decide medical necessity; orders over Rs 2 lakh payout

Oriental Insurance rejects claim saying hospitalisation wasn't necessary: A Delhi consumer commission has ordered Oriental Insurance to pay Rs 2.24 lakh to a woman whose health insurance claim was rejected after the insurer declared her hospitalisation unnecessary. The commission found that the company had no basis to override the treating doctor's clinical judgment, particularly when it produced no medical evidence of its own to contest the claim.