Dubai: Medical Claim Denied? Here's What You Can Do To Dispute Refusal By Insurer

Question: If an insurer in Dubai denies a legitimate medical claim , can I dispute it? What would the legal process look like if they do not agree?

Answer: An insurance company is required to pay for health benefits, cover emergency treatment from out-of-network providers until the beneficiary's life is no longer at risk, and ensure the beneficiary can access all rights granted under the health insurance policy. This is in accordance with Article 13 (1) (2) and (3) of Dubai Health Insurance Law No. 11 of 2013

“An Insurance Company must:

1. Pay the cost of health benefits;

2. Pay the cost of the health benefits provided by a health service provider that is not part of the health service provider network in an emergency case until the beneficiary's life is no longer threatened;

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3. Allow the beneficiary to obtain, by all means available, all his rights as determined in the health insurance policy;”

Furthermore, the Dubai Health Authority (DHA) may establish a system for resolving disputes related to health insurance, requiring parties to utilise this system before seeking judicial or arbitral remedies. This is in accordance with Article 21 of the Dubai Health Insurance Law.

“The DHA may establish a system for the settlement of disputes arising out of health insurance, and may make it mandatory for health insurance parties, prior to recourse to the courts or arbitration.”

Furthermore, while filing a complaint with the Dubai Health Insurance Corporation affiliated to the DHA (DHIC), the complaint must include the personal details of the complainant, clearly describe the details of the complaint and what the complainant is requesting, accompanied by all supporting documents, in Arabic, or both Arabic and English, and follow any additional requirements set by the DHIC. This is in accordance with Article 28 (b) of the Administrative Resolution No. (78) of 2022 Issuing the Implementing Bylaw of Law No. (11) of 2013 Concerning Health Insurance in the Emirate of Dubai.

“a. The DHIC will consider the complaints filed with it regarding the health services covered by the health insurance system or health insurance policies.

b. A complaint filed with the DHIC must:

1. Contain the personal details of the complainant;

2. Contain the details of the complaint, including a clear and precise description of the complainant's requests;

3. Be accompanied by all the documents that support the complaint;

4. Be written in Arabic or in both the Arabic and English languages; and

5. Meet any other requirements prescribed by the DHIC.”

In accordance with the aforementioned provision, it is assumed that you hold a valid health insurance policy in Dubai, have submitted a legitimate claim, and have approached the insurance company regarding the same, which has rejected your claim without providing a valid and acceptable explanation. Under these circumstances, you may dispute the insurer's decision by filing a complaint with the DHA, which may intervene if the refusal of the insurance company is unjustified and lacks merit.

Ashish Mehta is the founder and Managing Partner of Ashish Mehta & Associates. He is qualified to practise law in Dubai, the United Kingdom and India. Full details of his firm on: Readers may e-mail their questions to: ... or send them to Legal View, Khaleej Times, PO Box 11243, Dubai.

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