Kalaburagi commission orders insurer to pay ₹2.39 lakh after claim denial

The Kalaburagi District Consumer Disputes Redressal Commission has ordered Niva Bupa Health Insurance to pay ₹2,39,574 to a policyholder following the wrongful denial of a cashless claim.

The dispute arose when the complainant, Shali Nazir, sought cashless treatment for her son's knee surgery at Apollo Hospitals in Bengaluru. Although the insurance company initially granted permission for cashless treatment, it revoked the authorization at the time of discharge, claiming the 24-month waiting period for the specific ailment had not been met. This forced the family to pay ₹2,24,574 out of pocket.

The Commission ruled that the company's decision to grant initial permission and subsequently withdraw it constituted a service deficiency. The total ordered payment includes the medical expenses, ₹10,000 for mental agony and service deficiency, and ₹5,000 for litigation costs. Failure to pay within 45 days will result in a 6% interest rate starting from July 28, 2026.