Knife attack on the common man: A spotlight on insurance disparities

Er. Parthapratim Phukan

(Aizawl, Mizoram)

The shocking knife attack on actor Saif Ali Khan during a burglary at his Mumbai home has sparked widespread attention, not only for the celebrity but also for the glaring inequities in India’s health insurance system. While the nation sympathizes with Mr Khan and prays for his recovery, the incident has exposed how preferential treatment in insurance claims favours celebrities and high-profile individuals, leaving ordinary citizens to navigate a complex and often discriminatory process.

Following the incident, reports revealed that a cashless request of nearly Rs 36 lakh was submitted for Mr. Khan’s five-day hospital stay, of which Rs 25 lakh was swiftly approved by his insurer, Niva Bupa. While such efficiency and coverage are commendable in emergencies, this stands in stark contrast to the treatment meted out to the common man, who often faces delays, rejections, and inadequate coverage when making claims. The disparities in the system are indicative of deeper systemic flaws, where the insurance process is riddled with ambiguities and fallacies that disproportionately impact ordinary policyholders.

One of the major issues faced by the common man is the lengthy and often bureaucratic pre-authorization process required for cashless claims. Unlike celebrities, whose claims are often approved within hours, ordinary policyholders frequently encounter delays that can have life-threatening consequences. For instance, Suresh Kumar, a small business owner from Jaipur, was involved in a car accident and required emergency surgery. Despite submitting all necessary documentation for pre-authorization, the insurer delayed approval for over 48 hours, forcing his family to pay Rs 2 lakh upfront to ensure his surgery could proceed on time.

Moreover, insurance policies are often drafted with vague and ambiguous language, creating opportunities for insurers to exploit technicalities. Exclusions such as “pre-existing conditions” or “non-standard treatments” are commonly cited reasons for partial or complete claim rejections. Priya Menon, a retired teacher from Kerala, found herself in this predicament during her cancer treatment. Her chemotherapy claim was partially denied because it included “non-standard drugs,” even though her doctor provided all necessary certifications. Left to bear Rs 3 lakh in expenses herself, Priya’s experience highlights how such vague terms can leave policyholders vulnerable.

Another common grievance is the disparity in cashless treatment limits. Celebrities and those with corporate policies often enjoy higher caps, allowing them to access top-tier healthcare without concern for costs. In contrast, ordinary citizens are constrained by low reimbursement limits that do not reflect the actual costs of treatment. Ravi Sharma, a schoolteacher in Delhi, experienced this firsthand when his ICU coverage was capped at Rs 5,000 per day, far below the Rs 15,000 he was charged. Despite holding a valid insurance policy, Ravi’s family had to borrow money and sell assets to cover the shortfall.

Even after treatment, the process of reimbursement is fraught with challenges. Excessive demands for documentation are a common tactic used to delay or deny claims. Anjali Verma, a homemaker from Lucknow, was asked to repeatedly submit notarized medical records and even unrelated documents like income certificates. Despite complying, her claim for a minor surgery was rejected on the grounds of “incomplete documentation.” Such practices, often referred to as “document fatigue,” discourage many policyholders from pursuing their rightful claims, leaving them to bear the financial burden themselves.

The lack of transparency in rejection decisions adds to the frustration. Insurance companies often provide vague explanations for denials, making it difficult for policyholders to challenge them. Ajay Desai, a software engineer from Pune, had his claim for a knee replacement surgery denied as “medically unnecessary,” despite a clear recommendation from his doctor. These opaque practices erode trust in the system and leave policyholders feeling helpless.

The cumulative impact of these systemic issues is devastating for the common man. Families already struggling with medical emergencies are pushed into debt and emotional distress due to the inefficiencies of the claims process. For many, insurance—which is meant to provide financial security—becomes a source of anxiety and frustration. Worse still, these experiences erode trust in the system, prompting many policyholders to stop renewing their policies altogether.

The Saif Ali Khan incident starkly highlights the two-tier healthcare system perpetuated by the insurance sector. Celebrities and high-profile individuals receive preferential treatment, while the common man is left to fight for basic coverage. This disparity not only undermines the principles of fairness and equality but also raises serious questions about the accountability of the Insurance Regulatory and Development Authority of India (IRDAI), which is responsible for ensuring transparency and fairness in the industry.

Reforming the system is imperative. Insurers must adopt standardized and transparent claim approval processes with clear timelines to prevent unnecessary delays. Policy language should be simplified to eliminate ambiguities, and coverage limits should be reviewed to reflect rising healthcare costs. The IRDAI must take a more proactive role in holding insurers accountable for unfair practices, introducing penalties for unnecessary claim rejections and delays.

Additionally, efforts must be made to educate policyholders about their rights and the claims process. Public awareness campaigns can empower citizens to challenge unfair decisions and demand better service from their insurers. By addressing these systemic flaws, the insurance sector can move closer to its intended purpose: providing financial security and peace of mind to all policyholders, irrespective of their social or economic status.

While we collectively condemn the attack on Saif Ali Khan and recognize the need for swift action in emergencies, his case serves as a reminder of the inequities faced by ordinary citizens. Health insurance must be a safeguard for everyone, not a privilege reserved for a select few. Only by addressing these disparities can we ensure a just and equitable healthcare framework for all.