A Mumbai resident has shared his year-long struggle with health insurer Niva Bupa, detailing how he eventually managed to recover his full claim amount after months of delays, repeated follow-ups, and finally the intervention of the Insurance Ombudsman.
Posting under the subreddit r/InsuranceTroubleIndia, he described the experience as a “year of hell” that began with his mother’s hospitalization in June 2024.
The Hospital Dispute
According to his account, the dispute started when his mother was declared fit for discharge, but the hospital bill remained unpaid due to a stuck cashless claim. Despite assurances from Niva Bupa that the settlement would be processed “in two hours,” the family was left waiting for seven days.
With no resolution in sight, they were forced to pay the hospital bill of ₹3,17,983.86 out of pocket, even taking a loan to secure her release. Niva Bupa assured them of a full reimbursement, but the matter dragged on.
Months of Partial Payments
Between July and August 2024, the claimant said he repeatedly submitted the same documents and received new case numbers every time he contacted customer service. Payments eventually began trickling in after he took to social media, tagging the company repeatedly.
Instead of a lump sum, Niva Bupa reimbursed him in smaller amounts—₹12,000, ₹15,000, and ₹35,000—before closing the case midway. At that point, he had recovered only about half of the total amount. The company advised him to approach the Ombudsman if he was unsatisfied.
The Ombudsman Process
He filed a complaint with the Insurance Ombudsman on August 6, 2024, marking the start of a long procedural journey.
- October 2024: The Ombudsman’s office requested physical copies of documents. He personally visited their office on October 11, submitting a detailed file.
- December 2024: His complaint was officially registered, and he was asked to submit additional Annexure VI and VI-A forms, which he provided on December 13.
- January – May 2025: The case remained pending as the Ombudsman’s office worked through a backlog of earlier complaints. He was informed in April 2025 that cases filed in July 2024 were still under review.
- June 20, 2025: He received confirmation that his case was scheduled for a hearing on June 24, 2025—almost exactly a year after the hospital discharge.
However, on June 23, 2025, a day before the scheduled hearing, the Ombudsman’s office informed him that Niva Bupa was ready to settle the outstanding amount without further proceedings. He agreed to the settlement.
Final Settlement
The process did not end there. Despite agreeing to pay, Niva Bupa initially demanded a formal written order from the Ombudsman, even though the case had already been marked as closed. After another month of follow-ups, the final balance was credited to his account at the end of July 2025, bringing the year-long ordeal to an end.
Lessons for Policyholders
The Redditor said the experience highlighted the challenges customers face in securing legitimate claims, despite paying for health insurance. His case also demonstrated the importance of persistence and the role of the Ombudsman in resolving disputes.
“It was exhausting, but in the end, you can win if you don’t give up,” he wrote.
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About the Author: Donald Gonsalves
