Question: If my medical claim is denied by an insurer in Dubai, can I contest it? What steps should I take if they refuse to cooperate?
Answer: In Dubai, insurance companies must cover health benefits, pay for emergency treatments from out-of-network providers until the policyholder’s life is no longer at risk, and ensure access to all policy rights, as per Article 13 (1) (2) and (3) of Dubai Health Insurance Law No. 11 of 2013.
An Insurance Company is obligated to:
1. Cover health benefits costs;
2. Pay for emergency health services from non-network providers until the situation is no longer life-threatening;
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3. Grant beneficiaries access to all rights under their health insurance policy;
Additionally, the Dubai Health Authority (DHA) can set up a dispute resolution system for health insurance issues, which parties must use before considering court or arbitration, as stated in Article 21 of the Dubai Health Insurance Law.
The DHA may implement a system to settle health insurance disputes, making it mandatory for parties to use before legal action.
When filing a complaint with the Dubai Health Insurance Corporation (DHIC), include personal details, complaint specifics, and requests, with supporting documents in Arabic, or both Arabic and English, following DHIC’s additional requirements, as per Article 28 (b) of Administrative Resolution No. (78) of 2022.
The DHIC will evaluate complaints about health services under the insurance system or policies.
Complaint requirements:
1. Include personal details of the complainant;
2. Clearly describe the complaint and requests;
3. Attach all supporting documents;
4. Be written in Arabic or both Arabic and English;
5. Fulfill any other DHIC requirements.
If you have a valid health insurance policy in Dubai, submitted a legitimate claim, and the insurer unjustifiably denied it, you can dispute their decision by filing a complaint with the DHA, which may intervene if the denial lacks merit.
Ashish Mehta is the founder and Managing Partner of Ashish Mehta & Associates, qualified to practice law in Dubai, the UK, and India. More information at: www.amalawyers.com. Send questions to: news@khaleejtimes.com or Legal View, Khaleej Times, PO Box 11243, Dubai.
