No Causal Link Between Past Medical Treatment And Current Illness, Northwest Delhi District Commission Holds HDFC Life Insurance Co Liable

In a recent case, the District Consumer Dispute Redressal Commission-V, Northwest Delhi bench, found HDFC Life Insurance Company accountable for deficient services by rejecting a valid claim without obtaining an independent medical opinion. The complainant had a mediclaim policy with HDFC Life and incurred Rs. 80,000 in medical expenses due to acute febrile illness. Despite submitting all required documents, the insurer denied the claim, citing non-disclosure of past ileocecal TB in the application form. The commission observed that the insurer failed to seek an independent medical opinion after receiving a certificate from the treating doctor affirming no connection between past TB treatment and the current illness. It deemed the rejection arbitrary and unfair, directing HDFC Life to pay Rs. 80,000 with interest and Rs. 30,000 for mental agony and expenses.