Dharwad: The District Consumer Grievances Redressal Commission has ruled in favour of a policyholder after finding deficiency in service by HDFC ERGO General Insurance for partially denying a medical insurance claim related to dengue treatment.The complainant, Yallappa Walikar, a resident of Rajaji Nagar in Hubballi, had purchased a family health insurance policy from the company and was paying an annual premium of Rs 23,072. On May 23, 2024, while visiting Vaddigere village in Shivamogga district with his family, his daughter developed health complications and was diagnosed with dengue by doctors. She was admitted to hospital for two days, and the total medical expenditure amounted to Rs 11,000.
After discharge, the complainant submitted a claim as per policy norms. However, the insurance company rejected the full claim, citing violation of policy conditions and offered to settle only Rs 9,000. Alleging deficiency in service under the Consumer Protection Act, the complainant approached the Dharwad District Consumer Disputes Redressal Commission on Dec 3, 2024 seeking relief.After detailed examination, Commission president Ishappa Bhute and member Vishalakshi A Bolashetti observed from records that the insurance policy was valid and active at the time of hospitalisation. The Commission also noted that hospital admission and medical expenses of Rs 11,000 were supported by documentary evidence. It stated that the purpose of insurance is to provide financial support during illness or accidents, and refusal to honour the valid claim amounted to deficiency in service.The Commission directed the insurance company to reimburse the full medical expense of Rs 11,000 with 8% annual interest from Aug 15, 2024 (date of claim rejection) until full payment. It also ordered the company to pay Rs 50,000 towards compensation for mental agony and inconvenience, and Rs 10,000 towards litigation expenses.
