vinngh
New member
- Policy Name
- Health Insurance
- Company Name
- Niva Bupa Health Insurance Limited
- Customer Care Number
- 1860 500 8888
- Loss Amount
- 897164
- Ratings
- Opposite Party Address
- Niva Bupa Health Insurance Company Ltd.
3rd Floor, Capital Cyberscape,
Sector-59, Gurugram - 122 102,
Haryana, India
Through its Authorized Representative / Officer-in-Charge
BEFORE THE HON'BLE CONSUMER DISPUTES REDRESSAL COMMISSION
Complainant: Vinay Kumar Singh
Opposite Party: Niva Bupa Health Insurance Company Ltd.
Subject: Complaint against Wrongful Claim Rejection and Illegal Policy Termination
Respected Sir/Madam,
I have been a continuous health insurance policyholder since 22 March 2018 under Care Health Insurance (Policy No. 12269927). On 10 March 2026, I ported my policy to Niva Bupa Health Insurance (Policy No. 61021362202600) after their authorized sales representative assured me that, as per IRDAI portability guidelines, all continuity benefits, including waiting period credits and coverage earned since 2018, would continue. I possess the call recording of this assurance. Based on these representations, I purchased a five-year policy valid until 21 March 2031.
At the time of porting, my wife was healthy, carrying out normal daily activities, and was neither hospitalized nor advised surgery. Her previous examination in September 2025 showed only a minor endometriosis cyst that required no treatment which we further reconfirmed with Cloudshine Pune in November 2025 , and even our family physician in January 2026 did not identify any serious illness. Therefore, there was no diagnosed or material medical condition requiring disclosure during the proposal process.
In April 2026, after the policy had commenced, my wife developed severe abdominal and back pain. We consulted several hospitals, including Aditya Birla Hospital, Tata Memorial Hospital, local hospitals, and finally Shree IVF Centre, Ghatkopar, where Dr. Jay Mehta diagnosed Deep Pelvic Endometriosis after extensive investigations conducted on 17-19 May 2026. Surgery was performed on 27-28 May 2026, resulting in medical expenses of approximately ₹12.8 lakh.
My corporate health insurance covered ₹5 lakh, and I submitted the remaining claim to Niva Bupa on 30 May 2026. I promptly responded to every query raised by the insurer and submitted all requested medical documents.
However, on 17 July 2026, Niva Bupa rejected my claim and terminated my policy, alleging that my wife had a pre-existing Deep Pelvic Endometriosis which was intentionally concealed while purchasing the policy. This allegation is entirely false.
The disease for which surgery was performed was diagnosed only in May 2026, after the policy had already commenced. The insurer has incorrectly treated the minor findings of September 2025 as equivalent to the advanced disease diagnosed in May 2026. Medical conditions can progress over time, and no policyholder can disclose a diagnosis that did not exist or was unknown at the time of submitting the proposal.
Further, the proposal form was not filled by me. Due to technical issues with the online proposal link, the entire proposal was completed over a telephone call by Niva Bupa's own sales representative. She asked only a few questions and entered all responses herself. I relied upon her expertise and had no opportunity to independently verify each entry. Any omission or recording error by the insurer's representative cannot later be used to deny a genuine claim.
Throughout the process, I acted honestly and in good faith. I never concealed any known medical information nor attempted to obtain insurance fraudulently. If I had intended to suppress facts, I would not have ported an existing policy that I had continuously maintained since 2018. My objective was only to continue my existing coverage with continuity benefits.
Niva Bupa accepted my proposal after its underwriting process, collected the premium, and issued the policy without seeking additional medical records, previous reports, or medical examinations. Allegations of non-disclosure arose only after a substantial claim was submitted. Such conduct defeats the very purpose of health insurance and is arbitrary, unfair, and amounts to deficiency in service and unfair trade practice.
The wrongful rejection of my claim and termination of my policy have caused severe financial hardship and immense mental agony to my family. Besides bearing substantial medical expenses, I have also lost continuous insurance protection that I had maintained for more than eight years.
I have already approached the appropriate authorities, and the details are as follows:
Yours faithfully,
Vinay Kumar Singh
Richa Singh
Complainant: Vinay Kumar Singh
Opposite Party: Niva Bupa Health Insurance Company Ltd.
Subject: Complaint against Wrongful Claim Rejection and Illegal Policy Termination
Respected Sir/Madam,
I have been a continuous health insurance policyholder since 22 March 2018 under Care Health Insurance (Policy No. 12269927). On 10 March 2026, I ported my policy to Niva Bupa Health Insurance (Policy No. 61021362202600) after their authorized sales representative assured me that, as per IRDAI portability guidelines, all continuity benefits, including waiting period credits and coverage earned since 2018, would continue. I possess the call recording of this assurance. Based on these representations, I purchased a five-year policy valid until 21 March 2031.
At the time of porting, my wife was healthy, carrying out normal daily activities, and was neither hospitalized nor advised surgery. Her previous examination in September 2025 showed only a minor endometriosis cyst that required no treatment which we further reconfirmed with Cloudshine Pune in November 2025 , and even our family physician in January 2026 did not identify any serious illness. Therefore, there was no diagnosed or material medical condition requiring disclosure during the proposal process.
In April 2026, after the policy had commenced, my wife developed severe abdominal and back pain. We consulted several hospitals, including Aditya Birla Hospital, Tata Memorial Hospital, local hospitals, and finally Shree IVF Centre, Ghatkopar, where Dr. Jay Mehta diagnosed Deep Pelvic Endometriosis after extensive investigations conducted on 17-19 May 2026. Surgery was performed on 27-28 May 2026, resulting in medical expenses of approximately ₹12.8 lakh.
My corporate health insurance covered ₹5 lakh, and I submitted the remaining claim to Niva Bupa on 30 May 2026. I promptly responded to every query raised by the insurer and submitted all requested medical documents.
However, on 17 July 2026, Niva Bupa rejected my claim and terminated my policy, alleging that my wife had a pre-existing Deep Pelvic Endometriosis which was intentionally concealed while purchasing the policy. This allegation is entirely false.
The disease for which surgery was performed was diagnosed only in May 2026, after the policy had already commenced. The insurer has incorrectly treated the minor findings of September 2025 as equivalent to the advanced disease diagnosed in May 2026. Medical conditions can progress over time, and no policyholder can disclose a diagnosis that did not exist or was unknown at the time of submitting the proposal.
Further, the proposal form was not filled by me. Due to technical issues with the online proposal link, the entire proposal was completed over a telephone call by Niva Bupa's own sales representative. She asked only a few questions and entered all responses herself. I relied upon her expertise and had no opportunity to independently verify each entry. Any omission or recording error by the insurer's representative cannot later be used to deny a genuine claim.
Throughout the process, I acted honestly and in good faith. I never concealed any known medical information nor attempted to obtain insurance fraudulently. If I had intended to suppress facts, I would not have ported an existing policy that I had continuously maintained since 2018. My objective was only to continue my existing coverage with continuity benefits.
Niva Bupa accepted my proposal after its underwriting process, collected the premium, and issued the policy without seeking additional medical records, previous reports, or medical examinations. Allegations of non-disclosure arose only after a substantial claim was submitted. Such conduct defeats the very purpose of health insurance and is arbitrary, unfair, and amounts to deficiency in service and unfair trade practice.
The wrongful rejection of my claim and termination of my policy have caused severe financial hardship and immense mental agony to my family. Besides bearing substantial medical expenses, I have also lost continuous insurance protection that I had maintained for more than eight years.
I have already approached the appropriate authorities, and the details are as follows:
- Care Health Policy No.: 12269927
- Niva Bupa Policy No.: 61021362202600
- Claim ID: 53834281 / 53834281-01
- Corporate Policy: 22796952
- IRDAI Token: 07-26-016733
- Ombudsman Complaint ID: ONL-PUN-H-031-2627-00868
- E-Jagrati Case ID: 202607251213
- Declare the rejection of my claim and termination of my policy as illegal and arbitrary.
- Direct Niva Bupa to reinstate my health insurance policy with all continuity benefits carried from my previous insurer.
- Direct Niva Bupa to approve and settle my hospitalization claim in accordance with the policy terms.
- Award compensation for the financial loss, mental agony, and harassment caused to me and my family.
- Award litigation costs and pass any other order deemed fit in the interest of justice.
Yours faithfully,
Vinay Kumar Singh
Richa Singh