A consumer court in Chandigarh has delivered a scathing rebuke to Aditya Birla Health Insurance, directing the company to reimburse medical expenses and pay compensation for mental harassment and litigation costs. The case involves Sanjeev Rana, who purchased a health insurance policy with a coverage of ₹5 lakh. Rana was hospitalized at Max Super Specialty Hospital in Mohali in April 2024 due to severe dehydration and high creatinine levels, and the hospital submitted a claim to Aditya Birla Health Insurance. However, the insurance company rejected the claim, citing that Rana’s admission was unnecessary and that his treatment could have been managed in an outpatient department.
The consumer court found the insurance company’s decision to be arbitrary and emphasized that the treating physician is the sole authority to determine the necessity of a patient’s admission. The court, therefore, ordered Aditya Birla Health Insurance to pay Rana’s medical expenses of ₹54,228, along with interest, and imposed a compensation of ₹15,000 for mental anguish and legal expenses.
The court’s order serves as a reminder that consumers have recourse against unfair practices in the insurance sector. The court expressed its disapproval of the arbitrary practices employed by insurance companies, who readily accept premiums but resort to unreasonable pretexts when claims are filed. The order has mandated that the insurance company comply with the order within 60 days. This case highlights the importance of consumer protection and the need for insurance companies to be more transparent and accountable in their dealings with customers.