New Delhi, July 24 -- A Delhi consumer commission has held that a health insurer cannot reject a mediclaim simply by stating that hospitalisation was not medically necessary when the treating doctors had advised admission and the insurer failed to produce any medical evidence to support its stand. In a recent order, the commission directed Oriental Insurance Company Ltd. to pay more than Rs.2.24 lakh to a policyholder after finding the claim rejection amounted to deficiency in service.

The case involved Shivani Tomar, who had been covered under a health insurance policy issued by Oriental Insurance since November 2010. She was admitted to Max Healthcare Hospital, Vaishali, in November 2023 after suffering from chest heaviness, breathless...