- Loss Amount
- 900000
- Ratings
To,
The Hon'ble Consumer Disputes Redressal Commission
Subject: Complaint Against Niva Bupa Health Insurance for Misselling of Policy and Wrongful Rejection of Genuine Medical Claim
Respected Sir/Madam,
I respectfully submit this complaint against Niva Bupa Health Insurance for mis-selling a health insurance policy (policy no-34593833202601), withholding material information at the time of sale, and subsequently rejecting a genuine claim, thereby causing immense financial hardship, mental agony, and emotional distress to my family.
At the time of purchasing the policy, a representative from Niva Bupa visited our residence and explained the benefits of the insurance plan. We were specifically informed that all major illnesses and treatments would be covered after 30 days of the policy commencement and that there were no significant limitations or restrictions that would affect future claims. Based on these assurances, we purchased the policy in good faith.
The representative hurried us through the documentation process and asked us to sign various documents without giving us sufficient time to read and understand the policy terms and conditions. Important exclusions, limitations, waiting periods, disease-specific conditions, and claim restrictions were never properly explained to us. Had these facts been disclosed honestly and transparently, we would have made a different decision regarding the purchase of the policy.
After maintaining the policy continuously for approximately one and a half years, my father suffered a serious and life-threatening medical condition. This illness was never diagnosed prior to the purchase of the policy, was not a pre-existing disease, and had no relation whatsoever to any previous medical condition. It developed unexpectedly and required urgent medical intervention to save his life.
Despite this, Niva Bupa rejected our claim.
As a result, our family was forced to bear medical expenses of approximately ₹9,00,000 entirely from our own resources. We belong to a lower-middle-class family and were financially incapable of bearing such an enormous burden. To arrange funds for my father's treatment, we had to borrow money from relatives, friends, and well-wishers. The financial impact on our family has been devastating and continues to affect us even today.
We possess complete documentary evidence of every expense incurred during my father's treatment. We have hospital bills, pharmacy bills, diagnostic reports, payment receipts, discharge summaries, bank transaction records, and all supporting documents covering the entire treatment period of approximately six months. These records clearly establish the genuineness of the treatment, the necessity of the expenses, and the severe financial burden imposed upon our family.
Following the claim rejection, I contacted Niva Bupa on multiple occasions and repeatedly informed them that the policy had been mis-sold and that critical information had not been disclosed at the time of sale. I specifically requested them to review their sales records, call recordings, and internal communications, as these interactions would clearly demonstrate the assurances given to us before purchasing the policy. However, despite several attempts to seek a fair resolution, the company has failed to provide any meaningful response or reconsideration of our case.
What is most painful is the complete lack of sensitivity shown towards a family that was dealing with a life-threatening medical emergency. Health insurance is purchased to obtain financial protection during difficult times. However, when we needed support the most, the insurer chose to deny our claim rather than stand by the promises made during the sale of the policy. It appears that once the premium is collected and the policy is sold, the interests and hardships of policyholders are ignored.
The actions of Niva Bupa have caused not only financial loss but also tremendous mental stress, emotional suffering, and loss of trust. We purchased the policy in good faith, disclosed information honestly, paid premiums diligently, and maintained the policy for more than 1.5 years. Yet, when faced with a genuine medical emergency, we were left to struggle alone.
In view of the above facts and circumstances, I humbly request the Hon'ble Commission to:
I sincerely hope that our grievance will be heard and that appropriate relief will be granted.
Yours Faithfully,
Rajinder Singh
The Hon'ble Consumer Disputes Redressal Commission
Subject: Complaint Against Niva Bupa Health Insurance for Misselling of Policy and Wrongful Rejection of Genuine Medical Claim
Respected Sir/Madam,
I respectfully submit this complaint against Niva Bupa Health Insurance for mis-selling a health insurance policy (policy no-34593833202601), withholding material information at the time of sale, and subsequently rejecting a genuine claim, thereby causing immense financial hardship, mental agony, and emotional distress to my family.
At the time of purchasing the policy, a representative from Niva Bupa visited our residence and explained the benefits of the insurance plan. We were specifically informed that all major illnesses and treatments would be covered after 30 days of the policy commencement and that there were no significant limitations or restrictions that would affect future claims. Based on these assurances, we purchased the policy in good faith.
The representative hurried us through the documentation process and asked us to sign various documents without giving us sufficient time to read and understand the policy terms and conditions. Important exclusions, limitations, waiting periods, disease-specific conditions, and claim restrictions were never properly explained to us. Had these facts been disclosed honestly and transparently, we would have made a different decision regarding the purchase of the policy.
After maintaining the policy continuously for approximately one and a half years, my father suffered a serious and life-threatening medical condition. This illness was never diagnosed prior to the purchase of the policy, was not a pre-existing disease, and had no relation whatsoever to any previous medical condition. It developed unexpectedly and required urgent medical intervention to save his life.
Despite this, Niva Bupa rejected our claim.
As a result, our family was forced to bear medical expenses of approximately ₹9,00,000 entirely from our own resources. We belong to a lower-middle-class family and were financially incapable of bearing such an enormous burden. To arrange funds for my father's treatment, we had to borrow money from relatives, friends, and well-wishers. The financial impact on our family has been devastating and continues to affect us even today.
We possess complete documentary evidence of every expense incurred during my father's treatment. We have hospital bills, pharmacy bills, diagnostic reports, payment receipts, discharge summaries, bank transaction records, and all supporting documents covering the entire treatment period of approximately six months. These records clearly establish the genuineness of the treatment, the necessity of the expenses, and the severe financial burden imposed upon our family.
Following the claim rejection, I contacted Niva Bupa on multiple occasions and repeatedly informed them that the policy had been mis-sold and that critical information had not been disclosed at the time of sale. I specifically requested them to review their sales records, call recordings, and internal communications, as these interactions would clearly demonstrate the assurances given to us before purchasing the policy. However, despite several attempts to seek a fair resolution, the company has failed to provide any meaningful response or reconsideration of our case.
What is most painful is the complete lack of sensitivity shown towards a family that was dealing with a life-threatening medical emergency. Health insurance is purchased to obtain financial protection during difficult times. However, when we needed support the most, the insurer chose to deny our claim rather than stand by the promises made during the sale of the policy. It appears that once the premium is collected and the policy is sold, the interests and hardships of policyholders are ignored.
The actions of Niva Bupa have caused not only financial loss but also tremendous mental stress, emotional suffering, and loss of trust. We purchased the policy in good faith, disclosed information honestly, paid premiums diligently, and maintained the policy for more than 1.5 years. Yet, when faced with a genuine medical emergency, we were left to struggle alone.
In view of the above facts and circumstances, I humbly request the Hon'ble Commission to:
- Hold Niva Bupa Health Insurance accountable for mis-selling the policy and failing to disclose material terms and conditions.
- Direct the insurer to honor and settle our genuine claim.
- Order reimbursement of the medical expenses incurred by our family.
- Award compensation for the mental agony, emotional distress, harassment, and financial hardship suffered by us.
- Award litigation costs and any other relief deemed fit in the interests of justice.
- Take appropriate action against the insurer for unfair trade practices and deficiency in service.
I sincerely hope that our grievance will be heard and that appropriate relief will be granted.
Yours Faithfully,
Rajinder Singh