Shubham Tanwar raises a complaint against PolicyBazaar & NivaBupa, alleging claim delays, fake promises, and unfair practices during hospitalization. Read the full case with legal insights, consumer rights, and FAQs on Choice4Voice.com
Complaint Summary
| Details | Information |
|---|---|
| Complainant Name | Shubham Tanwar |
| Not disclosed | |
| Company/Brand | PolicyBazaar & Niva Bupa Health Insurance |
| Complaint Type | Insurance Claim Delay / Deficiency in Service |
| Product/Service | Health Insurance |
| Issue Description | Claim delays, demand for advance deposit, poor customer service, broken escalation process |
| Financial Impact | Nearly ₹5 lakhs demanded upfront, ₹12,500 paid extra out-of-pocket |
| Date of Incident | July – September 2025 |
| Company’s Response | No meaningful resolution provided |
| Complaint Source | Shared via LinkedIn post |
| Additional Notes | Complainant warns others to avoid PolicyBazaar & NivaBupa due to unethical practices |
Full Complaint Write-Up
Shubham Tanwar, a Senior Software Engineer, shared a detailed and alarming experience about his mother’s hospitalization and insurance claim struggle with PolicyBazaar and NivaBupa Health Insurance.
Despite being insured, his family allegedly faced harassment and negligence when they needed financial assistance the most.
Allegations Against PolicyBazaar
- “Dedicated support” promised in advertisements was missing in reality.
- Relationship Manager and claim advisor were inaccessible; only WhatsApp group messages were sent.
- Gurgaon office was closed when the complainant visited for urgent help.
- Emails to customer support bounced back due to full inbox.
Allegations Against NivaBupa
- No timely approvals for hospitalization extensions from July 27 onwards.
- Demanded ₹5 lakhs upfront to continue treatment, despite valid policy coverage.
- Delayed approvals (18+ hours vs. the promised 3-hour TAT), leading to extra charges.
- False promises from senior staff with no resolution.
- Forced the complainant to spend ₹12,500 from his own pocket.
Emotional & Financial Impact
- Family had to arrange huge funds during critical care.
- Mental stress due to uncertainty and delays.
- Loss of workdays because of follow-ups with insurance representatives.
The complainant has strongly advised others to avoid both PolicyBazaar and NivaBupa, highlighting how advertisements and promises collapse in real emergencies.
Legal Context: IRDAI Guidelines on Insurance Claims
As per the Insurance Regulatory and Development Authority of India (IRDAI):
- Cashless claims must be settled within 2 hours of request.
- Insurers cannot force policyholders to deposit advance money if policy covers hospitalization.
- Customer grievance redressal must be functional (emails, helplines, escalation officers).
- Delays or wrongful denial can make insurers liable for compensation and penalties.
If an insurance company violates these norms, policyholders can:
- File a complaint with the Insurance Ombudsman.
- Approach the IRDAI Grievance Cell via IGMS portal.
- File a case under the Consumer Protection Act, 2019 for deficiency of service.
Consumer Rights in Insurance Disputes
- Right to Timely Claim Settlement – Insurers must approve or reject claims within a reasonable time.
- Right to Fair Treatment – No harassment, false promises, or misleading advertisements.
- Right to Escalation – Policyholders can escalate complaints to the Grievance Redressal Officer.
- Right to Compensation – Consumers can claim damages for financial losses and mental agony.
Q&A Section
Q1: Can an insurance company legally demand advance deposits during hospitalization?
No. If the policy provides cashless coverage, such demands violate IRDAI rules.
Q2: What is the maximum time allowed for cashless claim approval?
Typically 2 hours under IRDAI’s guidelines for health insurance claims.
Q3: Where can policyholders complain if claims are delayed?
To the Insurance Ombudsman, IRDAI Grievance Cell, or Consumer Forum.
Q4: What documents should be preserved during such disputes?
Hospital bills, discharge summaries, claim forms, email/WhatsApp communication with insurers.
Q5: Can customers sue both broker (PolicyBazaar) and insurer (NivaBupa)?
Yes. Both can be held liable for deficiency in service under the Consumer Protection Act.
Q6: What is the Insurance Ombudsman’s role?
To resolve insurance disputes up to ₹30 lakhs in a cost-free and time-bound manner.
Q7: Are advertisements like “dedicated claim support” legally binding?
Yes. Misleading advertisements fall under Unfair Trade Practices.
Q8: What steps should Shubham Tanwar take immediately?
- File a written complaint with NivaBupa and PolicyBazaar.
- Escalate to IRDAI through the IGMS portal.
- Approach the Insurance Ombudsman.
Q9: Can a consumer claim compensation for mental stress?
Yes. Consumer courts often grant compensation for harassment and financial loss.
Q10: How can other consumers avoid such problems?
Buy insurance directly from reputed insurers, verify claim settlement ratios, and check recent customer reviews.
📌 Note from Choice4Voice.com:
This complaint has been published after verification. We urge PolicyBazaar and NivaBupa to resolve the issue immediately in line with IRDAI’s claim settlement regulations.
