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DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION GURGAON-

122001.

Consumer Complaint No.523 of 2025 Date of Institution: 21.05.2025 Date of Decision: 01.07.2026 Neeraj Kumar Singhal son of Shri Hirdidaya Krishan, H. No.106, HIVO Apartment, Sector-15, Part-II, Gurugram-122001.

…..Complainant Versus

1-Yashoda Superspeciality Hospital and Cancer Institute, B 1 and 2, Sector - 23, Sanjay Nagar, Ghaziabad 201001.

2- Manager- Grievance Redressal Team, Niva Bupa Health Insurance Company Limited, 2nd Floor, Logix Infotec Park, Plot No. D-5, Sector-59, Noida – 201309.

3- Swati Sinha, TPA Department, Yashoda Hospital & Cancer Institute, B 1 & 2, Sec.

23, Sanjay Nagar, Ghaziabad 201001.

4- Manager, Niva Bupa Health Insurance Company Limited - Registered Office, C/98, 1st Floor, Block C, Lajpat Nagar 1, New Delhi – 110024.

5- DR. VIVEK KUMAR, MBBS, MD, DM, Senior Consultant Cardiologist, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi- 110076.

.....Opposite parties Complaint under Section 35 of Consumer Protection Act, 2019.

BEFORE: SHRI SANJEEV JINDAL, PRESIDENT.

MS. JYOTI SIWACH, MEMBER.

MS. KHUSHWINDER KAUR, MEMBER.

Present: Shri Mangal Chand, Advocate for the complainant.

OPs No. 1, 2 & 5 proceeded ex-parte vide order dated 27.05.2025.

OP No.3 given up vide order dated 27.05.2025.

OP NO.4 proceeded ex-parte vide order dated 07.05.2026.

ORDER SANJEEV JINDAL, PRESIDENT.

Shorn off unnecessary details, briefly stated, it is the case of the complainant that he was insured vide policy bearing No.32660186202402 from the OP No.4 i.e. Niva Bupa Health Insurance Company Limited valid for the period from 30.08.2024 to 29.08.2025. Earlier, in June 2022 the complainant had experienced back ache, pursuant to which, he had consulted Dr. Vivek Kumar and his report had been shown at the time of purchasing the present subject insurance policy.

In March-April, 2025, the complainant had to get himself admitted in Yashodha Hospital, Ghaziabad for the treatment of Malignant Neoplasm of Colon disease and had incurred more than Rs.5,36,613/- in that regard. The OP No.4- insurance company had been provided with all the requisite medical documents coupled with the estimates and the reports provided by the hospital, but, still, the OP No.4-insurance company cancelled the policy without adopting any legal process on the basis of 20-30% Stenosis and despite the fact that it was a normal treatable disease. Besides, in Yashodha Hospital aforesaid, the complainant had to face a number of irregularities in the form of billing without GST number, his forcible captivity and whimsical billing of Rs.2,12,541/- relating to the medicines etc.. The complainant in this regard also made complaints to the President of India Secretariat, Prime Minister Office (PMO), Insurance lokpal and Deputy Commissioner as well as served the legal notice on the OPs No. 1 to 5, but to no avail.

On April 9, 2025, the complainant again had to get himself admitted in Yashodha Hospital during which period the billing amount of Rs.5,72,000/- had been forcibly received from him, whereas, the OP No.4-Insurance company had given sanctioned only with respect to the amount of Rs.3,80,000/-. After aforesaid treatment, due to complexities of surgery, the complainant again had to get himself admitted on April 20^th, 2025, but the OP-Insurance Company did not cover it.

In the process aforesaid, the amount of Rs.45,592/- had been forcibly obtained from him by the Yashodha Hospital, Ghaziabad on 23.04.2025. Further, the amount of Rs. 48,245/- on account of medical testing & the amount of Rs.19,650/- as taxi rent also had to be incurred by the complainant, which amounts still had not been sanctioned. Hence, this complaint. In the end, the complainant prayed that the OP No.1-Apollo Hospital & Cancer Institute and the OP No.4-Niva Bupa Health Insurance Company Limited be directed to pay the amounts of Rs.45,592/- + Rs.48,245/-+ Rs.19,650/- (medical expenses, bill of medical testing repo