Mohali, June 16 – The District Consumer Disputes Redressal Commission here has directed HDFC ERGO Health Insurance (formerly Apollo Munich) to reimburse ₹2 lakh to a policyholder for wrongfully denying a mediclaim. The insurer has also been ordered to pay ₹30,000 as compensation for mental harassment and litigation costs.
The complainant, Kuldeep Singh Sandhu, a resident of TDI City, Kharar, had purchased a group mediclaim policy through Canara Bank, Phase 10 branch, in the name of his wife, Jaspal Kaur. The policy offered a ₹5-lakh cover for both and was valid from November 30, 2019, to November 29, 2020.
On March 6, 2020, Sandhu was admitted to Sri Guru Harkrishan Sahib Eye Hospital, Sohana, with symptoms including vomiting, vertigo, and slurred speech. A request for cashless treatment was denied by HDFC ERGO three days later, citing a pre-existing Coronary Artery Disease (CAD). The insurer also terminated the policy on March 10.
Challenging the claim, Sandhu submitted medical certificates from two doctors, including a cardiologist, who confirmed that he had no history or symptoms of CAD and had been on a preventive blood thinner since 2008.
Despite the evidence, the insurer refused reimbursement, forcing Sandhu to pay ₹1,01,953 for the initial hospitalisation and ₹99,053 for a second admission on March 18.
The commission held the insurer guilty of deficiency in service and unfair trade practices, stating that no credible evidence was submitted to prove pre-existing CAD.
It observed that insurers often entice customers at the time of selling policies but later deny genuine claims. The commission directed HDFC ERGO to reimburse the full hospital bill with 6% annual interest from the date of discharge (March 23, 2020) within 30 days, failing which the interest would be raised to 9% per annum.
