IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Ahmedabad
Award Ref: CIO/DNH-DAMAN-DIU-UT/2024
Dadra & Nagar Haveli and Daman & Diu Hospital Billing & Health Insurance Dispute Guide
Statutory Protections, Insurance Ombudsman Jurisdiction & Hospital Recovery across Dadra & Nagar Haveli and Daman & Diu
Total Hospital Billed
₹250,000
Arbitrary TPA Cut
₹48,500
Legally Recoverable
₹48,500
Deterministic Math Comparison: TPA Cut vs. IRDAI May 2024 Statutory Math
| Line Item / Disputed Component | Billed (₹) | TPA Cut (₹) | Statutory Approved (₹) | Recoverable Overcharge (₹) | IRDAI Statutory Reference |
|---|---|---|---|---|---|
| State Average Titanium Joint / Stent Cut | ₹115,000 | ₹26,000 | ₹115,000 | ₹26,000 | Clause 19 Protection |
| State Average OT Consumables Slashed | ₹22,000 | ₹13,000 | ₹22,000 | ₹13,000 | Annexure-1 Allow-List |
Verbatim IRDAI Circulars & Statutory Citations
State CIO Jurisdiction — Ahmedabad
Adjudicates claims under Insurance Ombudsman Rules 2017.
Citation: Ministry of Finance Gazette Notification
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Where can I file an insurance complaint against unfair deductions in Dadra & Nagar Haveli and Daman & Diu?
Policyholders in Dadra & Nagar Haveli and Daman & Diu can escalate unresolved deductions to the Insurance Ombudsman Centre in Ahmedabad or lodge an electronic complaint on Bima Bharosa.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Ahmedabad)
Address: Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, Ahmedabad - 380001
States & UTs Covered: Gujarat, Dadra & Nagar Haveli, Daman and Diu