The Karnataka High Court has ruled that health insurance claims cannot be rejected merely because a treatment did not require hospitalisation. According to reports from Mint, Justice Suraj Govindaraj delivered this significant ruling on 1 September 2026 in W.P. No. 14682 of 2024 (GM-RES), M/s National Insurance Co Ltd & Anr. v. Padmanabha Shetty G & Ors. The court dismissed the insurer's writ petition and upheld a Permanent Lok Adalat order directing payment of ₹2.85 lakh with applicable interest.
The policyholder was covered under a health insurance scheme for retired employees of member banks with annual coverage of ₹9 lakh for the period from 1 November 2021 to 31 October 2022. As reported by Mint, he was undergoing treatment for Stage IV carcinoma of the prostate and had received chemotherapy at HCG Hospital in Bengaluru. His doctors subsequently advised Zoladex and Xgeva injections once every three months as part of his continuing treatment. The insurer had reimbursed several medical expenses but refused to reimburse ₹2,85,470 spent on the two injections.
The High Court rejected the insurer's argument that the injections did not require hospitalisation, noting that hospitalisation is a means of administering medical treatment and not an end in itself. According to Mint, Justice Suraj Govindaraj observed that medical advances allow treatments that previously required hospital admission to be administered without hospitalisation. The court held that the fact that treatment was administered without hospitalisation could not, by itself, determine whether it was connected with the disease covered by the policy.
As reported by Mint, the judgment does not mean that every outpatient treatment will automatically qualify for reimbursement. The court considered the specific medical treatment, underlying disease, and policy language while noting that exclusion clauses must be considered in the context of the policy as a whole. The ruling could be relevant for policyholders whose treatment involves injections, procedures, or other medical care that can be administered without an overnight hospital stay, but the exact terms, conditions, and exclusions of individual policies will continue to matter.
The Karnataka High Court directed the insurer to pay ₹2.85 lakh with applicable interest and ₹50,000 as costs. According to Mint, this ruling provides important relief as more treatments, including injections and procedures, are increasingly administered without overnight hospital stays. The key takeaway is that non-hospitalisation alone may not be enough to reject a health insurance claim where the treatment is demonstrably connected with the disease covered by the policy.
