IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Chandigarh
Award Ref: CIO/JAMMU-AND-KASHMIR/2024
Jammu & Kashmir Hospital Billing & Health Insurance Dispute Guide
Statutory Protections, Insurance Ombudsman Jurisdiction & Hospital Recovery across Jammu & Kashmir
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 — Chandigarh
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 Jammu & Kashmir?
Policyholders in Jammu & Kashmir can escalate unresolved deductions to the Insurance Ombudsman Centre in Chandigarh or lodge an electronic complaint on Bima Bharosa.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Chandigarh)
Address: S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D, Chandigarh - 160017
States & UTs Covered: Punjab, Haryana, Himachal Pradesh, J&K, Ladakh, Chandigarh