3 min readChandigarhUpdated: Feb 15, 2026 10:25 AM IST
The bench observed that the insurer failed to produce credible medical records proving the disease existed within 48 months prior to policy inception, as required under policy terms to classify it as pre-existing. (Photo generated using Gemini)
The District Consumer Disputes Redressal Commission, Chandigarh, has ruled that insurers often “show all types of green pastures to customers while selling policies, but invent excuses to deny claims when claim is sought,” while directing Niva Bupa Health Insurance Company Limited to pay Rs 27.99 lakh with interest to a cancer patient whose reimbursement claims were rejected.
The order, passed on February 9, 2026, by Commission president Amrinder Singh Sidhu and member Brij Mohan Sharma, came on a complaint filed by Vidya Bhushan Sharma, a Sector 43B resident. He had taken a health insurance policy effective October 2021 after porting his earlier coverage and had disclosed that he underwent angioplasty in 2008.
In January 2022, Sharma developed chest pain and tests at Fortis Hospital, Mohali, Max Hospital, Mohali and PGIMER, Chandigarh, diagnosed him with stage-4 metastatic lung cancer. Doctors advised urgent immunotherapy, which he underwent repeatedly. Being a senior citizen with no regular income, he filed reimbursement claims totalling Rs 14.52 lakh, but the insurer rejected them citing alleged non-disclosure of pre-existing disease and cancelled the policy.
He approached the Insurance Ombudsman, Chandigarh, which ordered payment of Rs 1.85 lakh for one claim and restoration of the policy. Later, Sharma sought reimbursement of additional medical bills amounting to Rs 27.99 lakh for ongoing treatment of immunotherapy and chemotherapy but the insurance company allegedly failed to respond, leading him to file a consumer complaint.
The insurance company in reply argued that the claim was rightly denied because the complainant had allegedly suppressed material facts, contending he had been suffering from lung cancer for two years prior to the policy. The company relied on investigation papers and discharge summaries to support its stand.
However, the commission found serious gaps in the insurer’s evidence. It noted that the investigation documents were unsigned and unsupported by affidavits from investigators or treating doctors.
The bench observed that the insurer failed to produce credible medical records proving the disease existed within 48 months prior to policy inception, as required under policy terms to classify it as pre-existing.
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It is settled law that burden of proof lies upon the insurer to establish pre-existence of disease by producing credible medical records predating the policy and mere bald assertions or post-facto medical opinions do not discharge this burden. Hence, mere provisional diagnosis of the insured patient at the time of hospitalisation in February 2022 cannot retrospectively convert the alleged ailment into pre-existing disease, held the commission.
Citing settled law, the commission emphasised that the burden to prove pre-existing illness lies on the insurer and cannot be shifted to the consumer through unsubstantiated allegations. It noted that Sharma was 68 when he ported the policy and that if the insurer chose not to conduct a thorough medical examination before issuing coverage, the consumer could not be penalised for that omission.
Concluding that the rejection of claim was arbitrary and amounted to deficiency in service and unfair trade practice, the commission partly allowed the complaint. It directed the insurer to pay Rs 27,99,215 with 9 per cent annual interest from March 18, 2023, along with Rs 20,000 as compensation and litigation cost.
Jagpreet Singh Sandhu is a Senior Correspondent at The Indian Express, based in Chandigarh. He is a veteran reporter with over a decade of experience, specializing in legal, crime, and environmental reporting across the tri-city area (Chandigarh, Mohali, and Panchkula).
Professional Background
Core Beat: He primarily covers the Punjab and Haryana High Court, District Courts, CBI Courts, and Consumer Commissions. His legal reporting is known for breaking down complex judgments and tracking long-standing criminal cases.
Environmental Reporting: Jagpreet has become a key voice in reporting on the deteriorating air quality and weather patterns in the Punjab-Haryana region.
Crime & Technology: He frequently reports on cybercrime, digital arrest scams, and the intersection of technology and law enforcement, such as the development of citizen-centric policing apps.
Recent Notable Articles (Late 2025)
His late 2025 coverage has focused on significant judicial verdicts, major financial scams, and public health concerns:
1. Legal & CBI Court Verdicts
"12 years on, CBI court acquits Haryana judge, parents in wife’s death case" (Dec 17, 2025): Detailed coverage of the acquittal of a judicial officer in a high-profile dowry death case from 2013.
"‘Wicked & evil mind’: Court gives man 30-year term for kidnapping, sexually assaulting 8-year-old" (Dec 16, 2025): A report on a stern judgment from a Chandigarh district court in a POCSO case.
"Man acquitted in rape case after victim found ‘very happy’ in wedding reception" (Dec 9, 2025): Covering a unique legal observation regarding consensual relationships and age verification.
2. Investigative & Scams
"CBI registers FIR in Rs 1.14-cr Patient Welfare Grant scam at PGIMER" (Dec 19, 2025): An exposé on how funds meant for poor patients were siphoned off through forged documents and a photocopy shop inside the PGIMER campus.
"Month-long torture, Rs 85 lakh transfers: How ‘Innocence Certificate’ led to a ‘digital arrest’ of an elderly couple" (Dec 12, 2025): Detailing a sophisticated cyber fraud targeting senior citizens in Chandigarh.
3. Environment & Public Safety
"Panchkula air turns ‘very poor’, fourth worst in country" (Dec 22, 2025): Reporting on the sudden spike in pollution levels in Panchkula compared to neighbouring cities.
"Soon, you can snap that overspeeding car, and report to Chandigarh Police" (Dec 16, 2025): Breaking news on a new mobile application being developed to allow citizens to report traffic violations via geo-tagged photos.
4. Gangster Culture & Crime
"City Beautiful in the crosshairs of gangsters" (Dec 14, 2025): A feature analysis of how Chandigarh has increasingly become a staging ground for extortion and rivalries between gangster modules.
"Shooters wanted for Parry murder held by Delhi Police Special Cell" (Dec 18, 2025): Following the developments in a high-profile murder case in Chandigarh’s Sector 26.
Signature Style
Jagpreet is recognized for his tenacious follow-up on cold cases and his ability to report on courtroom drama with a focus on victim rights. His work often highlights administrative lapses, whether in the handling of patient welfare funds or the enforcement of environmental standards. ... Read More
