Patients Can Take Legal Action If Insurers Deny Prescribed Procedures, Say Dubai Regulations

Patients whose health insurance companies refuse to approve medically prescribed procedures have the right to seek legal recourse under the provisions of Dubai’s health insurance law, according to recent regulatory updates.

 

Under Dubai Health Insurance Law No. 11 of 2013, insurance companies are legally obliged to pay for the health benefits covered in a patient’s policy and to ensure access to all rights stipulated under that coverage. The law further mandates that insurers must cover emergency treatments, even if the provider is outside the approved medical network, until the patient’s life is no longer at risk.

 

Insurer’s Obligations under Law

 

According to Article 13 (1), (2) and (3) of the law, an insurance company must:

 

• Pay the cost of health benefits as outlined in the insurance policy.
• Cover emergency medical services provided by an out-of-network facility until the patient’s condition stabilises.
• Allow the insured person to access all entitlements under the policy.

 

The Article 20 of the same law reinforces that the insurance company bears the cost of treatment as per the terms of the policy, even while retaining the right to recover the amount later from any entity legally responsible for payment.

 

Mandatory Dispute Resolution before Legal Action

 

The Dubai Health Authority (DHA) has also established a system to resolve disputes related to health insurance before they reach the courts. Under Article 21 of the law, parties to a dispute must first utilise this DHA-managed system before pursuing judicial or arbitral remedies.

 

This provision ensures that patients have an accessible mechanism to raise grievances when they believe an insurer has unlawfully denied coverage for necessary treatment.

 

Filing a Complaint with the DHA

 

The complaint process is governed by Administrative Resolution No. (78) of 2022, which issued the Implementing Bylaw of the Dubai Health Insurance Law. Complaints are handled by the Dubai Health Insurance Corporation (DHIC), a body affiliated with the DHA.

 

Under Article 28 (b) of the resolution, a complaint must:

 

• Include the complainant’s personal details;
• Provide a clear description of the issue and the relief sought;
• Attach all supporting medical and insurance documents;
• Be written in Arabic or in both Arabic and English; and
• Meet any additional requirements set by the DHIC.

 

Once submitted, the DHIC will review the case and determine whether the insurer’s actions are in line with the provisions of the law and the insurance policy terms.

 

Next Steps for Patients

 

If an insurance company rejects essential medical procedures prescribed by a doctor -- despite such procedures being covered under the policy -- patients should first submit a written complaint to the insurer supported by medical reports and policy details.

 

If the insurer fails to respond adequately or continues to deny the claim without valid justification, the patient can escalate the matter to the Dubai Health Authority through the DHIC. In serious or unresolved cases, patients may also seek independent legal advice to assess whether the insurer’s conduct constitutes a breach of its contractual or statutory obligations.

 

Importance of Reviewing Coverage

 

Before filing a complaint, patients are advised to carefully review their insurance policy documents to confirm whether the prescribed treatment is included under their coverage. A clear understanding of the policy terms and exclusions can help ensure that the complaint is well-founded and legally supported.

 

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