PwC Employee Wins $2M Insurance Battle After US Heart Attack

When a PwC employee collapsed from cardiac arrest and acute pancreatitis just days into a work assignment in Dallas, his insurance company refused to help, claiming diabetes he didn't know he had made him ineligible for coverage. Seven years later, India's National Consumer Disputes Redressal Commission has finally delivered justice.

The employee traveled to Dallas in July 2017 for a routine three-month assignment. Within three days of arriving, he fell critically ill and was rushed to Baylor University Medical Centre with acute pancreatitis, respiratory failure, and cardiac arrest.

He spent 55 days hospitalized, including weeks in intensive care. Medical bills climbed to over $328,000, more than 2 crore rupees.

PwC notified Bajaj Allianz within 24 hours and repeatedly requested the cashless treatment covered under their corporate travel insurance policy. The insurer initially acknowledged the claim and requested medical records, giving the employee hope that help was coming.

Then, while he was still fighting for his life in a foreign hospital, Bajaj Allianz rejected the entire claim. Their reason: a single elevated blood sugar reading suggested pre-existing diabetes, which they said disqualified him from coverage.

PwC had to arrange emergency payment through International SOS Assistance, eventually paying over $411,000 to save their employee's life. The company and employee filed a consumer complaint alleging wrongful denial and mental harassment during a medical crisis.

The Bright Side

The commission delivered a sweeping victory on May 27, 2025. The judges found that Bajaj Allianz provided zero evidence of actual diabetes diagnosis or treatment before the policy began.

Medical records from the hospital specifically stated "no previous history of diabetes." The court ruled that one elevated test result, without any prior prescriptions, doctor visits, or diagnoses, cannot prove a pre-existing condition.

The bench called the denial "arbitrary, unjustified and contrary to the medical material on record." They ordered Bajaj Allianz to pay the full claim amount plus interest and costs.

This ruling sets an important precedent for thousands of workers who travel internationally. Insurers can no longer deny emergency claims based on speculation about conditions the policyholder never knew existed.

The decision protects employees and their families from being abandoned during life-threatening medical emergencies far from home.