Mumbai, Nov 29: The District Consumer Disputes Redressal Commission, Mumbai Suburban, has delivered a strong judgment against Niva Bupa Health Insurance Company Limited, ordering the insurer to reimburse a policyholder ₹66,50,000 for expenses incurred during overseas cancer treatment. The Commission, in its order, found the company guilty of deficiency in service and engaging in unfair trade practice.
Juhu Resident’s Claim Rejected Despite Worldwide Coverage Plan\
The case was filed by a Juhu resident, Alok Rajendra Bector, who had purchased the “Heartbeat – Family First Platinum Policy” with worldwide coverage. The policyholder was undergoing treatment for colorectal cancer at a medical facility in the United States.
Despite informing the insurer before travelling abroad and generally fulfilling policy conditions, the claim for the critical overseas treatment was unilaterally repudiated by the company.
Insurer’s Earlier Illegal Cancellation at the Centre of Dispute
The core of the dispute centred on the insurer’s attempt to leverage its own previous illegal actions. The Commission noted that Niva Bupa had initially cancelled an earlier policy on the grounds of an alleged non-disclosure of asthma.
Crucially, both the Commission and an earlier Ombudsman award in 2020 had established that asthma was an illness completely unrelated to the complainant’s cancer diagnosis and therefore had no bearing on the risk or the claim.
Wrongful Cancellation Prevented Access to Cashless Facility
The court observed that Niva Bupa’s wrongful cancellation of the policy had the practical effect of preventing the policyholder from availing the cashless facility, a procedural requirement for such overseas claims. After failing to get justice, the policyholder filed a complaint before the Mumbai Suburban District Consumer Commission, challenging the repeated rejection of his claim.
Commission Slams Insurer for Causing Financial and Mental Harassment
The bench concluded that an insurer cannot rely on procedural gaps that are a direct result of its own unlawful act to later deny reimbursement. By doing so, the company had caused “financial loss, mental trauma, and harassment” to the complainant during an active cancer battle.
Commission Awards Reimbursement, Compensation and Costs
As a result, the District Consumer Commission has ordered Niva Bupa to pay the principal amount of ₹66,50,000. Additionally, the company must pay ₹30,000 as compensation and ₹10,000 towards litigation costs. Niva Bupa has been given a period of 60 days to comply, failing which the reimbursement amount will attract an interest rate of 6% per annum.
Lawyers Say Order Sends Strong Message to Insurance Industry
Commenting on the ruling, Advocate Rohit Lalwani and Sajal Khan, representing the complainant, emphasised that the order clarifies the need for consistent policy enforcement.
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They stated that an insurer cannot use technicalities resulting from its own wrongful conduct to avoid honouring a valid claim, sending an important message to both the insurance industry and consumers.
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