Dubai Health Insurance Law Provides Clear Legal Pathway to Dispute Denied Medical Claims Through DHA Complaint System

Dubai residents whose legitimate health insurance claims are denied by insurers now have a clear legal framework to challenge the decision, according to provisions under the emirate’s health insurance law.

 

Under Dubai Health Insurance Law No. 11 of 2013, insurers are legally required to honour their obligations. Article 13 of the law specifies that an insurance company must:

 

• Pay the cost of health benefits;

• Cover emergency treatment from out-of-network providers until the patient’s life is no longer in danger;

• Ensure the insured beneficiary can access all rights granted under the health insurance policy.

 

DHA’s Dispute Resolution Mechanism

In cases where disputes arise, the law empowers the Dubai Health Authority (DHA) to establish a dedicated system for resolving conflicts between insurers and policyholders. Article 21 of the law allows the DHA to make it mandatory for both parties to utilise this dispute resolution mechanism before approaching courts or arbitration.

 

This means that policyholders who believe their claims have been unfairly denied must first seek redress through the DHA’s channels rather than directly pursuing litigation.

 

Filing a Formal Complaint

The Dubai Health Insurance Corporation (DHIC), which operates under the DHA, handles complaints related to health insurance policies and services. According to Administrative Resolution No. (78) of 2022, a complaint must:

 

1. 1. Include the personal details of the complainant;

2. 2. Provide a clear description of the dispute and the relief sought;

3. 3. Be supported by all relevant documents;

4. 4. Be written in Arabic, or in both Arabic and English;

5. 5. Meet any additional requirements set by the DHIC.

 

The DHIC then reviews the complaint and determines whether the insurer’s refusal was justified. If the rejection lacks merit, the DHA may intervene in favour of the policyholder.

 

What it Means for Residents

The provisions ensure that insured individuals in Dubai are not left vulnerable when medical claims are denied without valid grounds. By requiring insurers to justify their decisions and by setting up a structured complaint system, the DHA strengthens consumer protection within the healthcare sector.

 

Experts advise policyholders to carefully document their claims and maintain all relevant records when filing complaints to increase the chances of a successful resolution.

 

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