A consumer commission in Kalaburagi has ordered Niva Bupa to pay ₹2,39,574 after reversing a cashless claim at discharge, highlighting issues with waiting periods and insurer conduct amid growing claim disputes across India.
A district consumer commission in Kalaburagi has ruled that a health insurer cannot approve cashless hospital treatment and then withdraw that approval at the point of discharge, citing a waiting-period clause to reject the claim.
The commission ordered Niva Bupa Health Insurance Company to pay ₹2,39,574 to the complainants, covering the hospital bill, compensation for deficient service and mental distress, and litigation costs. The case was filed by Shali Nazir and his son, Shali Khader Basha, against the insurer and Policybazaar Insurance Brokers.
According to the case record, Nazir had bought a family floater policy through Policybazaar for an annual premium of ₹37,460. The cover was for ₹10 lakh and included Nazir, his wife and son. The policy was first issued from November 11, 2022, to November 17, 2023, and was renewed for another year from November 18, 2023, to November 17, 2024.
During the renewed policy period, Basha developed sudden pain in his right knee. He was examined in Bengaluru in April and again at Apollo Hospital on June 15, 2024, where doctors advised surgery. The family sought cashless approval through the hospital, and the insurer initially agreed. But at discharge, the company reversed course by email and rejected the claim, saying the treatment fell under Clause 6.2(f) and that the 24-month waiting period had not been completed.
The commission, presided over by in-charge commissioner Malathi Guranna and member M. Lokesh, said the rejection was not justified after reviewing the policy dates, treatment timeline and documents submitted by the insurer. It took particular exception to the fact that approval was first granted and then withdrawn when the patient was leaving hospital. The insurer has been directed to pay the amount within 45 days, failing which interest at 6% a year will apply from July 28, 2026, until payment.
Niva Bupa appeared before the commission and contested the complaint, while Policybazaar did not appear despite notice and was proceeded against ex parte. The complainants were represented by advocate Vaijanath S. Zalaki, who later personally delivered the demand draft to their home after receiving it from the insurer, according to the case details.
The ruling comes as Niva Bupa has faced other recent disputes over claim handling and cashless access. In August 2025, the insurer suspended cashless treatment at all Max Hospitals across India after its agreement expired and tariff talks failed, forcing policyholders to pay upfront and seek reimbursement later, according to Business Standard, Livemint and Financial Express. Separately, consumer commissions in Hyderabad and Ghaziabad have also recently ordered the insurer to pay substantial sums in claim disputes, underlining the growing scrutiny around how health insurers handle approvals and rejections.
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