IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Ahmedabad
Award Ref: CIO/GUJARAT/2024
Gujarat Hospital Billing & Health Insurance Dispute Guide
Statutory Protections, Insurance Ombudsman Jurisdiction & Hospital Recovery across Gujarat
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 Gujarat?
Policyholders in Gujarat 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