#cashless treatment

Maharashtra State Consumer Disputes Redressal Commission rules that empanelled hospitals under the Rajiv Gandhi Jeevandayee Aarogya Yojana (RGJAY) must ensure cashless treatment for eligible patients and cannot recover costs directly. The hospital was held liable for deficiency in service and ordered to refund Rs. 80,660 with interest, reinforcing patient rights under healthcare schemes.

The Punjab & Haryana High Court has ruled that insurers cannot deny health claims based on speculative inferences about pre-existing conditions when no medical documentation supports the allegation at the time of denial. This sets a critical precedent protecting policyholders from arbitrary rejections and reinforces that exclusions must be explicitly stated, not inferred.