In Dubai, patients facing the rejection of essential medical procedures by their insurance companies have legal avenues to address such disputes. According to Article 13 (1), (2), and (3) of Dubai Health Insurance Law No. 11 of 2013, insurance providers are mandated to cover health benefits, including emergency treatments from out-of-network providers until the beneficiary’s life is no longer at risk. Additionally, insurers must ensure that beneficiaries can access all rights stipulated in their health insurance policies. Article 20 further reinforces this obligation, stating that the insurer must bear the cost of health benefits as per the policy terms. The Dubai Health Authority (DHA) has established a dispute resolution system under Article 21, which requires parties to utilize this mechanism before pursuing judicial or arbitral remedies. Complaints to the Dubai Health Insurance Corporation (DHIC) must include personal details, a clear description of the issue, supporting documents, and be written in Arabic or both Arabic and English, as per Article 28 (b) of Administrative Resolution No. (78) of 2022. Patients whose claims are unjustly denied should first submit a written complaint to the insurer with medical documentation. If unresolved, they can escalate the matter to the DHA or seek independent legal advice to assess potential breaches of contractual and statutory obligations. It is crucial for patients to review their insurance policies to confirm coverage for prescribed treatments. Ashish Mehta, founder of Ashish Mehta & Associates, emphasizes the importance of understanding one’s legal rights in such scenarios.
Dubai: Can patients take legal action if insurance company rejects prescribed procedures?
