Consumer commission orders Niva Bupa to pay ₹4 lakh, restore health policy
HYDERABAD: The District Consumer Disputes Redressal Commission-III, Hyderabad, has directed Niva Bupa Health Insurance Company Ltd to pay ₹3,95,029 with 9% annual interest to a policyholder after finding deficiency in service in the rejection of a health insurance claim.
The commission also awarded ₹50,000 towards travel expenses and mental agony, along with ₹10,000 towards litigation costs. It further declared the cancellation of the policy under Service Request No. 24004220 void ab initio and directed the insurer to restore the policy with all continuous renewal benefits.
Case filed in August 2025
The order was passed on August 31, 2026, in Consumer Complaint No. 211 of 2025 filed by Rayapu Vijaya Kumar Reddy against Niva Bupa Health Insurance Company Ltd. The complaint was filed on August 29, 2025.
The matter was heard by the District Consumer Disputes Redressal Commission-III, Hyderabad, comprising President M. Ramgopal Reddy and Lady Member J. Shyamala.
Kumar Reddy appeared as a party-in-person, while advocate G. Nagesh represented Niva Bupa Health Insurance Company Ltd.
Kumar Reddy had purchased a Super Top Up Policy – Health Recharge for himself and his wife, Sumalatha Rayapu. The policy offered a sum insured of ₹95 lakh with a deductible of ₹5 lakh.
Sumalatha underwent treatment at Gleneagles Global Health City in Chennai from March 3 to March 28, 2025. Doctors treated her for bilateral pneumothorax and right pleural endometriosis. She also underwent multiple surgeries during her hospital stay.
The total hospital bill came to ₹25,23,223. Care Health Insurance Ltd, another insurer, settled ₹20,91,021 after deductions.
Kumar Reddy then sought ₹4,07,670 from Niva Bupa, stating that the deductible under the top-up policy had already been met.
Niva Bupa registered the claim under Claim ID 2208478. However, the insurer rejected the claim on May 1, 2025.
Commission questions changing reasons for claim rejection
In its communication, Niva Bupa cited alleged non-disclosure of pre-existing medical conditions, including pneumothorax and endometriosis. The insurer also cancelled the policy.
Kumar Reddy sought a review of the decision and approached the insurer’s grievance team. During the proceedings, the commission noted a change in the insurer’s reason for rejecting the claim.
Niva Bupa later said various deductions left no amount payable. These included a ₹24,532 discount, the amount settled by another third-party administrator and non-payable items.
The commission noted that the insurer did not provide an itemised schedule for the alleged ₹4,31,210 in non-payable items.
It also found that Niva Bupa failed to establish active concealment by the policyholder. The insurer could not show a direct medical link between the 2019 medical history and the treatment received in 2025.
The commission said an insurer cannot keep changing the reasons for denying a claim. It also noted that the allegation of fraud under Clause 7.1.5 required proof, which the insurer failed to provide.
Niva Bupa directed to restore policy
The commission partly allowed the complaint and directed Niva Bupa to pay ₹3,95,029 with 9% annual interest from April 2025 until realisation.
The insurer must also pay ₹50,000 towards travel expenses and mental agony and ₹10,000 towards litigation costs. Together, these amounts take the monetary relief awarded by the commission to ₹4,55,029, besides interest.
The commission also directed Niva Bupa to restore the cancelled policy with all continuous renewal benefits.
The insurer has 45 days from receipt of the order to comply. The commission dismissed the remaining reliefs sought by the complainant.
