Health insurance is often seen as a safety net, especially for senior citizens who are more vulnerable to health issues. However, for Mr. NA, a senior citizen, his experience with Niva Bupa Health Insurance turned into a distressing ordeal of denied claims, policy cancellations, and emotional turmoil. This article delves into the details of his case, highlighting the challenges faced by vulnerable policyholders and the systemic issues within the insurance industry.
🏦 The Pressure to Switch Policies
Mr. NA had been a loyal customer of HDFC Ergo General Insurance since July 30, 2019. His son, Mr. AK, managed his policy and claims, and they had never faced any issues with HDFC Ergo. However, in 2024, during a visit to Indian Overseas Bank (IOB), they were approached by bank staff with an offer to port their health insurance policy to Niva Bupa.
The bank associate claimed that Niva Bupa offered superior services and even hinted that their relationship with IOB might suffer if they didn’t switch. Despite initial reluctance, Mr. NA and his son felt pressured and agreed to port the policy, trusting the bank’s assurances. The associate assured them that the porting would follow IRDAI guidelines and that they would receive enhanced support from Niva Bupa.
🩺 The Underwriting Process: A Flawed System?
In July 2024, Mr. NA submitted the necessary documents to Niva Bupa. On July 20, 2024, he underwent a telemedical examination with a doctor from Niva Bupa’s underwriting team. During the examination, Mr. NA disclosed all his pre-existing conditions, including diabetes, kidney issues, ureteric stones, and knee and leg pain, as well as past treatments and hospitalizations. Despite his age and medical history, no in-person examination was conducted.
On July 27, 2024, Niva Bupa issued a counteroffer letter, confirming that the policy would be ported with a loading of ₹9,462 for pre-existing conditions and BMI. Mr. NA paid a total of ₹56,775 for the annual policy premium. The policy document stated that there would be no waiting period for pre-existing conditions, as he had completed a 5-year coverage period under his previous policy. However, the sum insured was reduced from ₹8,25,000 to ₹7,50,000.
🏥 Health Crisis and Claim Rejections
In September 2024, Mr. NA’s health deteriorated, and he was admitted to NXXXX Healthcare Pvt. Ltd., where he was diagnosed with CAD (Coronary Artery Disease), CKD (Chronic Kidney Disease), and Bilateral Pneumonitis—all linked to his pre-existing conditions. He was hospitalized from October 30, 2024, to November 2, 2024, and filed a reimbursement claim for ₹1,25,900 (Claim ID: XXXXXXX).
Despite his discharge, Mr. NA’s condition did not improve. On November 12, 2024, he was rushed to IXXXXXX AXXXX Hospitals, where he was diagnosed with CKD, Chest Infection, and UTI (Urinary Tract Infection). He applied for a cashless claim, but Niva Bupa declined it, asking him to file a reimbursement claim instead. This caused immense financial and emotional stress, as Mr. NA had to arrange funds privately for his treatment. He was discharged on November 19, 2024, and filed a reimbursement claim for ₹3,68,319 (Claim ID: XXXXXXX).
⚖️ Unjust Claim Rejections and Policy Cancellation
On January 7, 2025, Mr. NA received a rejection for his first claim, citing “Chronic renal failure is a specific waiting period exclusion under the member benefit.” Shockingly, the rejection letter also accused him of “fraudulent activity” without providing any evidence. The letter stated, “If any claim made by the insured person is in any respect fraudulent, all benefits under this policy and the premium paid shall be forfeited.”
On the same day, Mr. NA received a policy cancellation notice from Niva Bupa, citing “non-disclosure of material information” related to a “known case of CKD since August 26, 2023.” This was entirely unfounded, as Mr. NA had disclosed all his medical conditions during the underwriting process. Niva Bupa provided no documentary evidence to support their allegations.
On January 17, 2025, his second claim was also rejected for the same reason, leaving Mr. NA without coverage during a critical time in his life.
📜 Regulatory Violations
Mr. NA’s case highlights several violations of IRDAI guidelines:
- Failure to Obtain Medical Records: Niva Bupa did not collect Mr. NA’s medical history from HDFC Ergo, as required during the porting process.
- Inconsistent Reasons for Rejection: The claim rejections cited a “waiting period,” while the policy cancellation cited “non-disclosure,” creating confusion.
- Ignoring the Moratorium Period: Mr. NA had completed 60 months of continuous coverage under his previous policy, which should have protected him from such exclusions.
🌟 A Final Word: Empathy and Accountability Matter
Mr. NA’s experience is a stark reminder that insurance companies must prioritize empathy and accountability, especially when dealing with senior citizens. Health insurance is not just a financial product; it’s a promise to protect policyholders during their most vulnerable moments.
Summary: A Tale of Two Standards 🎬 vs. 👴
While insurers like Niva Bupa often pass claims of Bollywood celebrities without much scrutiny, they put vulnerable senior citizens like Mr. NA through unnecessary trouble in the evening of their lives. This double standard is deeply unfair. Senior citizens, who have paid premiums faithfully, deserve the same respect and prompt service as anyone else. Let’s hope Mr. NA’s fight for justice leads to a fair resolution and serves as a wake-up call for the insurance industry to treat all policyholders with dignity and fairness.
Please note that the names of the clients involved in this case have been omitted to respect their privacy. All opinions expressed in this blog are based on the available facts and evidence and are intended for informational purposes only.
Image Disclaimer: The image used in this blog is AI-generated. Any resemblance to real persons, living or dead, or actual events is purely coincidental. The image is for illustrative purposes only and does not represent real individuals or events.
Going through almost the same turmoil myself. My father's policy was ported to Niva Bupa and cancelled due to missing disclosure of Arthritis. I had informed the tele calling agent already that he had this condition since 6 months. However, he ignored and did not add to pre-existing diseases saying that it is a recent diseases and not needed to be mentioned!
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