Navsari Commission Orders Insurer to Reimburse ₹64,291 to Patient
Surat: The District Consumer Disputes Redressal Commission (DCDRC), Navsari, has ruled that a mediclaim cannot be rejected merely because a patient’s medical report lacks a pathologist’s physical signature, especially in the digital documentation era.
The Commission directed a private health insurance company to reimburse ₹64,291 to a 34-year-old man who was hospitalised earlier this year for acute pancreatitis.
Patient Hospitalised for Acute Pancreatitis
According to case details, the patient had a mediclaim policy worth ₹11.5 lakh. He was admitted to a private hospital in Navsari in January 2025, after experiencing severe pain, weakness, and vomiting for three days.
Doctors diagnosed him with acute pancreatitis, and he remained hospitalised from January 11 to January 15, following which he was discharged.
The patient later submitted a claim of ₹64,921 to his insurer for reimbursement of medical expenses.
Insurer Rejects Claim Citing Document Discrepancies
As reported by The Times of India, the insurance company denied the claim, citing “discrepancies” in the medical documents.
It pointed to the absence of a pathologist’s signature on lab reports and alleged missing details such as outpatient (OPD) consultations.
The insurer also questioned the lab findings, arguing that the total leucocyte count (TLC) appeared normal and even claimed that vomiting could not occur during pancreatitis.
Court Finds Insurer’s Argument Baseless
After reviewing the evidence and hearing both parties, the Commission found that the insurer had failed to provide concrete proof of any fraud or discrepancy.
The court noted that in the digital age, many authentic lab reports are issued without manual signatures, and their validity can be verified electronically or through lab visits.
Digital Reports Cannot Be Disqualified
The Commission observed that absence of a handwritten signature cannot be a ground for rejecting legitimate medical claims.
“OPD consultation does not come into existence when the patient has emergency pain,” the bench stated, adding that the insurer’s argument about vomiting and electrolyte imbalance was scientifically inaccurate.
Commission Directs Insurer to Settle Claim
Citing unfair rejection and poor justification, the DCDRC directed the insurance firm to reimburse the full amount of ₹64,291 to the complainant.
The ruling underscores the need for insurance companies to adapt to digital medical record systems and avoid technical denials that unfairly disadvantage policyholders.
