Cashless approval cannot be withdrawn at discharge: Kalaburagi District Consumer Disputes Redressal Commission
The Kalaburagi District Consumer Disputes Redressal Commission ruled that insurance companies cannot withdraw cashless treatment approvals at the time of discharge. The insurer was ordered to compensate the policyholder for medical expenses and mental agony.
Why it matters
This ruling strengthens consumer protection against arbitrary claim denials by health insurance providers.
In a significant order in a health insurance claim dispute, the Kalaburagi District Consumer Disputes Redressal Commission has held that an insurance company cannot withdraw the approval for cashless treatment at the time of discharge from the hospital and reject the claim on the ground of a waiting period.
The commission has directed Niva Bupa Health Insurance Company to pay a total of ₹2,39,574 to the complainants, covering the medical expenses incurred for treatment, compensation for deficiency in service and mental agony, and litigation costs.
The order was recently passed by the commission, presided over by in-charge Commissioner Malathi Guranna and member M. Lokesh. The complaint was filed by Shali Nazir and his son Shali Khader Basha against Niva Bupa Health Insurance Company and Policybazaar Insurance Brokers Pvt. Ltd.
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