Rana, a resident of Sector 38 West, Dadumajra, had purchased an Active Assure Diamond health insurance policy covering ₹5 lakh. In April 2024, he was admitted to Max Super Specialty Hospital, Mohali, due to severe dehydration and increased creatinine levels. Despite the hospital submitting the claim, the insurance firm rejected it, arguing that Rana’s condition did not warrant hospitalization and could have been treated in the OPD.

Challenging the decision, Rana approached the consumer court, which ruled that the treating physician—not the insurance company—had the final say on the necessity of hospitalization. The commission, led by Chairman Amarinder Singh Sidhu and member Brij Mohan Sharma, directed the insurer to pay ₹54,228 plus interest for the medical expenses, along with ₹15,000 as compensation.

Slamming the insurance firm’s arbitrary practices, the commission emphasized that while companies readily accept premiums, they often resort to unreasonable excuses to deny claims. The firm has been given 60 days to comply with the order. This case serves as a strong reminder that consumers have legal recourse against unfair insurance practices.