Hyderabad consumer panel orders HDFC ERGO to reimburse ₹2.68 lakh dialysis claim, pay compensation
HYDERABAD: The District Consumer Disputes Redressal Commission-I, Hyderabad, has partly allowed a complaint filed by retired employee Subraveti Venkata Ramana against HDFC ERGO General Insurance Company and directed the insurer to reimburse a medical claim of ₹2,68,352 along with compensation and litigation costs.
The order was passed on May 8, 2026, in a complaint filed by Venkata Ramana, 62, a resident of New Nallakunta, Hyderabad, who challenged the rejection of his health insurance claim and cancellation of his policy.
According to the complaint, the policyholder had purchased a health insurance policy after paying a premium of ₹63,840. The insurer issued Policy No. 2814206891350900003 covering the period from October 22, 2024 to October 21, 2025, with a sum insured of ₹10 lakh.
The complainant stated that pre-existing conditions including diabetes and hypertension had been disclosed at the time of policy purchase. He claimed the customer information sheet provided coverage from day one for complications arising from these illnesses.
Insurer cited non-disclosure of kidney disease
Venkata Ramana was admitted to Renova Century Hospital on January 12, 2025 after a medical emergency and was advised dialysis treatment. He remained hospitalised until January 16, 2025.
The complainant alleged that despite having a valid policy, the insurer denied cashless treatment. After discharge, he filed a reimbursement claim with supporting bills.
However, the insurer cancelled the policy through a letter dated January 16, 2025, alleging suppression of material facts. HDFC ERGO argued that medical records showed the complainant had chronic kidney disease for two years before policy issuance and failed to disclose it.
The insurer maintained that insurance contracts operate on the principle of uberrimae fidei or “utmost good faith” and claimed that non-disclosure of the kidney condition affected underwriting decisions.
Commission relies on diabetes coverage clause
The Commission observed that the insurer had admitted denial of cashless treatment and subsequent cancellation of the policy.
It noted that doctors’ records referred to the condition as “presumed diabetic kidney disease (DKD)” and held that the policy specifically covered conditions, complications and ailments arising from Type 1 and Type 2 diabetes as well as hypertension from day one.
The Commission said denial of cashless treatment was inconsistent with the policy wording.
It also recorded that the hospital bill amount submitted by the complainant was neither disputed nor denied by the insurer.
Compensation capped at ₹50,000
The Commission declined the entire compensation sought by the complainant, observing that compensation should remain fair and equitable and should not become a source of profit.
The panel directed the opposite parties jointly and severally to:
- Reimburse ₹2,68,352 towards medical expenses;
- Pay compensation of ₹50,000;
- Pay litigation costs of ₹15,000.
The total liability ordered against the insurer stands at ₹3,33,352.
