Gurgaon: Holding a hospital and a health insurer guilty of deficiency in service, District Consumer Disputes Redressal Commission (DCDRC) has directed them to jointly pay over Rs 11 lakh to a city resident along with interest, compensation and litigation costs.Yashoda Superspeciality Hospital, Ghaziabad, and Niva Bupa Health Insurance will now pay Rs 11.6 lakh to Neeraj Kumar Singhal, resident of Sector 15. DCDRC found that Singhal’s evidence remained unrebutted as the opposite parties chose not to contest the proceedings.DCDRC ordered the opposite parties to jointly refund Rs 11,63,761, pay 9% annual interest from the date of filing of the complaint, Rs 50,000 as compensation for mental harassment and Rs 22,000 as litigation costs. DCDRC directed that the amount be paid within 45 days, failing which it would carry 12% annual interest until payment.DCDRC president Sanjeev Jindal — in his order issued last week — also directed Niva Bupa to continue the complainant’s health insurance policy till its natural validity period. The panel also observed that the complainant would be entitled to initiate execution proceedings in case of non-compliance and that the opposite parties could face prosecution under the Consumer Protection Act.Singhal purchased a health insurance policy from Niva Bupa for the period Aug 30, 2024, to Aug 29, 2025. He told the commission that he disclosed his previous medical history, including a coronary angiography report, while obtaining the policy. He also disclosed a coronary angiography report showing 20-30% stenosis.He was admitted to Yashoda Hospital, Ghaziabad, in March-April 2025 for treatment of malignant neoplasm of the colon, incurring medical expenses exceeding Rs 5.3 lakh. Despite receiving all medical records, the insurer cancelled the policy citing the coronary condition. The hospital allegedly issued bills without GST details, kept him under “forcible captivity”, raised arbitrary medicine bills, forced him to pay amounts beyond the insurer’s approved cashless limit.He later underwent admissions and surgeries for complications, but the insurer declined coverage. He also incurred expenses on medical tests and taxi travel, which were not reimbursed. He sought reimbursement of medical expenses, compensation, litigation costs and restoration of the insurance policy.“Although all medical records were furnished, the insurer cancelled the policy citing 20-30% coronary stenosis,” Singhal said. He also accused the hospital of arbitrary billing, charging amounts beyond the insurer’s approved cashless limit and forcing him to make additional payments during multiple admissions.The commission noted that the hospital, insurer and other opposite parties failed to appear despite service of notice and were proceeded ex parte. As no defence evidence was produced, the complainant’s documentary evidence remained unrebutted.
