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In difficult times, a person relies mostly on their family, doctor, and the insurance company. But when life is fighting death, and at that very moment, the insurance company abandons you, the pain is indescribable. This news from Mumbai not only brings relief but also proves that justice, even if delayed, is sure to arrive.
The Mumbai Suburban District Consumer Disputes Redressal Commission recently issued a highly sensitive judgment, ordering Niva Bupa Health Insurance Company Limited to pay ₹66.50 lakh to a policyholder battling cancer.
The Commission ruled that the denial of the claim was completely wrong and caused the patient immense mental, physical, and financial distress.
The Patient’s Story: Insurance Company Arbitrariness Amidst the Fight Against Cancer
Alok Rajendra Bector had purchased a worldwide medical insurance policy in 2017 for himself and his son, which included coverage up to ₹65 lakh.
On August 1, 2018, he was diagnosed with colorectal cancer. After receiving initial treatment in Mumbai, he traveled to the United States for better care. As per the rules, he timely informed the company about the treatment, diagnosis, and his travel abroad.
However, his troubles began when the insurance company rejected his first claim, stating that he had concealed a history of asthma, even though there was no connection between the two illnesses.
The Insurance Ombudsman clearly stated that there was no medical connection between asthma and colorectal cancer and that the company had canceled the policy on false grounds. This decision went in Bector’s favor, and some of his claim was also refunded.
The Second Claim: ₹88 Lakh Spent, but the Company Backed Out Again
Between March 2019 and March 2020, he spent ₹88,34,560 at the Memorial Sloan Kettering Cancer Center in the US. The treatment was life-saving, but when he filed a claim, the company found another reason, they claimed that overseas treatment was only covered under the cashless mode, not for reimbursement.
But the question was: How could the patient seek cashless approval when the company itself had previously canceled the policy?
The Commission outright rejected this argument, stating that it amounted to an unfair trade practice and that the patient was deliberately denied his rightful due.
The Door to Justice is Never Closed
The judgment, delivered in October by Commission President Samindra R. Sarvey and member Sameer S. Kamble, was in favor of the patient. The Commission held that:
- The insurance company unfairly rejected the claim.
- The policyholder suffered financial stress in a life-or-death situation.
- The company violated both rules and ethics.
Order to the Insurance Company:
- Payment of ₹66.50 lakh within 60 days.
- 6% annual interest in case of delay.
- ₹30,000 for mental agony.
- ₹10,000 for legal expenses.
Why is this Decision Important?
This is not just the story of one case, it is the hope for millions of Indians who pay their premiums on time and trust that insurance will be a shield in times of crisis. This decision shows that: “Insurance companies cannot act arbitrarily. Justice stands with the common citizen.”
This Journey of Struggle Will Bring Light to Many
Alok Bector’s fight was not just his own. It is an inspiration for everyone who has faced injustice in an insurance claim. This story gives us the message:
Speak up for what is right, and justice is bound to be served.
Disclaimer:
This article is based solely on publicly available information. Its purpose is not to advocate for or against any institution, company, or individual. Its purpose is to inform readers about the important events. For any legal queries or decisions, readers are strongly advised to consult a qualified legal expert.
Dr. Bidyut Barun Sarmah, with 22+ years of experience in print, electronic, and digital media, holds an MA and PhD in Mass Communication and Journalism. He has worked with AIR, Doordarshan, and the Publication Division under the Ministry of Information and Broadcasting. A published author and researcher, Dr. Sarmah writes extensively in both Assamese and English. He was also awarded a prestigious fellowship by the Ministry of Culture, Government of India, for his study on journalistic literature—an achievement that highlights his depth of scholarship and contribution to media studies. At Nest of News, he leads the editorial team and contributes across diverse topics.