Health Insurance Disputes in Dubai: What the Law Says When Insurers Refuse Treatment for Newly Diagnosed Medical Conditions

Residents in Dubai often assume that a comprehensive health insurance policy guarantees full coverage once a medical condition is diagnosed. However, disputes frequently arise when insurers decline to approve certain procedures, investigations or treatment plans — particularly when the illness has developed recently.

 

Under UAE law, health insurers are not permitted to arbitrarily deny medically necessary treatment that falls within the scope of the policy. The legal framework governing health insurance in Dubai places clear obligations on insurance providers to honour coverage and ensure beneficiaries can fully exercise their rights.

 

The Dubai Health Insurance Law requires insurance companies to provide health benefits strictly in accordance with the terms of the issued policy. This includes enabling insured members to access treatment through all available means, without unjustified obstruction or delay. The law makes it clear that coverage providers must bear the cost of medical services covered under the policy, even where another party may ultimately be responsible for payment.

 

In practical terms, this means that once a condition is diagnosed and a licensed medical practitioner prescribes a treatment plan, the insurer cannot refuse coverage unless there is a lawful and policy-based reason — such as an explicit exclusion, a waiting period clearly stated in the policy, or treatment that falls outside approved benefits.

 

Importantly, the law does not allow insurers to deny claims simply because a disease was “recently developed”. What matters is whether the condition and the prescribed treatment are covered under the insured benefits, and whether the policy terms have been complied with.

 

To protect insured members, Dubai has also established a mandatory dispute resolution mechanism for health insurance matters. Before approaching courts or arbitration, disputes must be channelled through the health insurance complaints system overseen by the Dubai Health Insurance Corporation, which operates under the Dubai Health Authority.

When submitting a complaint, the insured person must clearly outline the issue, provide complete personal details, include all supporting medical and policy documents, and ensure the complaint is submitted in Arabic or in both Arabic and English. Only complaints that meet these formal requirements are reviewed.

 

In many cases, residents are advised to first submit a written objection directly to the insurer, enclosing the doctor’s prescription, medical reports and relevant policy provisions. If the insurer continues to deny approval without a valid contractual or legal justification, the matter can then be escalated to the health insurance dispute authority for review.

 

Legal experts note that insurers are expected to act in good faith and in compliance with both contractual obligations and statutory duties. A refusal that contradicts the policy wording or undermines the insured’s lawful entitlement may amount to a breach of the health insurance regulations.

 

Nevertheless, policyholders are urged to carefully review their insurance contracts before escalating disputes. Coverage limits, exclusions, waiting periods and pre-authorisation requirements vary across plans. Understanding these terms is crucial in determining whether a denial is lawful or challengeable.

 

Where uncertainty remains, seeking independent legal advice may help assess whether the insurer’s refusal violates UAE health insurance laws and whether further legal remedies are available.

 

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