#mediclaim policy

The M.P. State Consumer Commission ruled that insurers cannot deny claims for intravitreal injections like Lucentis solely because they are administered as outpatient procedures, if certified by a medical professional as medically necessary. This sets a critical precedent for policyholders undergoing chronic eye treatments, ensuring coverage aligns with clinical reality rather than arbitrary hospitalization clauses.

The Supreme Court has ruled that amounts received under a Mediclaim policy are contractual benefits and cannot be offset against statutory compensation awarded by a Motor Accidents Claims Tribunal. This clarifies that double recovery principles do not apply, ensuring accident victims can retain both insurance payouts and tribunal-awarded damages without reduction.

Delhi State Consumer Commission rules that insurers cannot deny claims based on vague allegations but must substantiate deficiencies with documented proof. The Commission also mandates settlement within a reasonable timeframe, reinforcing consumer protection in mediclaim disputes.