Health Insurance Policy Cancellation: Gurugram Consumer Commission Holds Niva Bupa, Yashoda Hospital Liable For Deficiency In Service

The District Consumer Disputes Redressal Commission, Gurgaon, comprising President Shri Sanjeev Jindal and Members Ms. Jyoti Siwach and Ms. Khushwinder Kaur, held Yashoda Superspeciality Hospital and Niva Bupa Health Insurance Company Limited guilty of deficiency in service in a case where the complainant alleged arbitrary cancellation of his health insurance policy and irregular hospital billing during his treatment for colon cancer. Brief Facts The complainant, Neeraj Kumar Singhal, purchased a health insurance policy from Niva Bupa Health Insurance Company Limited, valid from August 30, 2024 to August 29, 2025. Before obtaining the policy, he had disclosed his previous medical history, including treatment for back pain and a coronary angiography report, to the insurer. The complainant was admitted to Yashoda Superspeciality Hospital, Ghaziabad, during March-April 2025 for treatment of malignant neoplasm of the colon, incurring medical expenses exceeding ₹5.36 lakh. Despite submitting all the requisite medical records and estimates, the insurance company allegedly cancelled his policy on the ground of a pre-existing coronary condition. He further alleged that the cancellation was arbitrary and carried out without following due process. The complainant also alleged that the hospital indulged in irregular billing practices by issuing bills without GST details, charging excessive amounts for medicines and illegally detaining him until payment was made. After being admitted again in April 2025 for further treatment and subsequent complications, he claimed that substantial medical expenses, diagnostic costs and transportation charges were wrongfully denied by the insurer, forcing him to bear the expenses personally. Alleging deficiency in service and unfair trade practices on the part of the hospital and the insurance company, the complainant approached the District Consumer Disputes Redressal Commission, Gurugram, seeking reimbursement of the unpaid medical expenses, compensation for mental and physical harassment, litigation costs and a direction to the insurer to continue his health insurance policy. The opposite parties did not contest the proceedings. Despite being duly served, Yashoda Superspeciality Hospital (OP No. 1), Niva Bupa Health Insurance Company Limited (OP Nos. 2 and 4), and Dr. Vivek Kumar (OP No. 5) failed to appear before the Commission and were proceeded ex parte, while OP No. 3 was given up by the complainant as an unnecessary party. Observations and Decision The Commission observed that the complainant had produced extensive documentary evidence, including premium receipts, medical records, discharge summaries, hospital bills, insurance correspondence and other supporting documents in support of his claims. It noted that OP Nos. 1, 2, 4 and 5, despite being duly served, chose not to contest the proceedings, while OP No. 3 had been given up as an unnecessary party. Consequently, the complainant's evidence remained unrebutted, and there was nothing on record to disbelieve or discredit his version. The Commission further observed that the additional medical expenses incurred by the complainant during the pendency of the complaint were also liable to be taken into consideration in accordance with settled legal principles. Allowing the complaint, the Commission held OP Nos. 1, 2, 4 and 5 jointly and severally liable for deficiency in service. It directed them to refund ₹11,63,761 to the complainant along with interest at 9% per annum from the date of filing of the complaint until realization. The Commission also awarded ₹50,000 as compensation for mental harassment, pain and agony and ₹22,000 towards litigation expenses. It further directed OP No. 4, Niva Bupa Health Insurance Company Limited, to continue the complainant's health insurance policy till its natural period of validity. The Commission directed the opposite parties to comply with the order within 45 days from the date of uploading of the order after the expiry of 24 hours therefrom, failing which the awarded amount would carry interest at 12% per annum for the same period until realization. Case Title: Neeraj Kumar Singhal v. Yashoda Superspeciality Hospital & Cancer Institute & Ors. Case No.: DC/62/CC/523/2025 Click Here To Read/Download Order

Health Insurance Policy Cancellation: Gurugram Consumer Commission Holds Niva Bupa, Yashoda Hospital Liable For Deficiency In Service

Praveen Mishra

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Praveen Mishra

Health Insurance Policy Cancellation: Gurugram Consumer Commission Holds Niva Bupa, Yashoda Hospital Liable For Deficiency In Service

Praveen Mishra

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Praveen Mishra

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