IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Mumbai
Award Ref: CIO/GOA/2024
Goa Hospital Billing & Health Insurance Dispute Guide
Statutory Protections, Insurance Ombudsman Jurisdiction & Hospital Recovery across Goa
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 — Mumbai
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 Goa?
Policyholders in Goa can escalate unresolved deductions to the Insurance Ombudsman Centre in Mumbai or lodge an electronic complaint on Bima Bharosa.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Mumbai)
Address: 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400054
States & UTs Covered: Mumbai Metropolitan Region & Goa