Delhi consumer commission tells National Insurance to pay Rs 1.1 lakh Covid claim cut

The Delhi State Consumer Disputes Redressal Commission has held that National Insurance Company wrongly cut Rs 1.1 lakh from a policyholder's Covid-19 hospital claim. In a judgment delivered on 28 October 2026, it dismissed the insurer's appeal and upheld a district commission order directing it to pay the balance with interest.

What Happened

According to the judgment, the policyholder, covered under a group mediclaim policy with a super top-up, was admitted to a hospital in Ghaziabad with severe Covid-19 from 4 November to 20 November 2020: 12 days in the ICU and four days in an isolation ward. The hospital charged Rs 15,000 a day for its ICU package and Rs 10,000 a day for its isolation package.

The policyholder claimed Rs 4,79,270. The insurer paid Rs 3,64,368 and disallowed Rs 1.1 lakh, saying the policy limited room rent to Rs 5,000 a day and ICU charges to Rs 7,500 a day.

The commission noted that the hospital's breakup showed the packages also covered other medical expenses, such as consultant visits, nursing charges and PPE kits, not only the bed. It held that the room-rent and ICU limits apply only to charges under those heads, and that other covered medical expenses cannot be disallowed merely because the hospital billed them inside a package.

The commission upheld the order of 2 July 2025 of the District Consumer Disputes Redressal Commission (North East), Delhi. That order directs the insurer to pay Rs 1.1 lakh with interest at 9% a year from the date the complaint was filed, and Rs 45,000 as compensation and litigation cost with 9% interest from the date of that order. The commission's judgment may be appealed.

What It Means

For policyholders, the ruling says that a room-rent or ICU limit in a health policy does not let an insurer treat the whole gap between a hospital's package rate and that limit as excess rent. Medical costs that the policy covers still have to be paid, even when the hospital bundles them into one daily package.

Policyholders whose claims were cut this way can ask the hospital for an item-wise breakup of any package. Those who cannot resolve a dispute with their insurer can seek help through the National Consumer Helpline (1915) or file a consumer complaint online through e-Daakhil.

Source: Consumer commission order