The Bombay High Court has ruled that an insured was not entitled to claim for medical expenses incurred in India after falling ill abroad, under the Overseas Travel Insurance Policy. The court has relegated the matter back to the Insurance Ombudsman for Mumbai while allowing a petition by Tata AIG General Insurance Co. Ltd.
Tata AIG had approached the HC challenging the ombudsman’s decision of May 4, directing the insurance company to allow claims by an insured for his continued treatment in India under his travel policy.
The insured took an Overseas Travel Insurance Policy titled as “Travel Guard Policy Silver without Sub Limits” from Tata AIG from January 17, 2023 to May 16, 2023. The insured and his wife went on a Europe tour on May 3. He claimed that during his travel, he experienced symptoms of vertigo for which took treatment in Rome. However, they had to cut short their trip and returned to India on May10, where he continued his treatment. He was admitted to a hospital from May 15 to 22 where he was diagnosed with Subacutes Infarct in the right Costerolateral Medulla.
He submitted a claim with the insurance company claiming the expenses incurred towards his treatment at hospital in India. Tata AIG denied the liability of claim on the basis of the Terms and Conditions of the Insurance Policy.
On a complaint, the Insurance Ombudsman directed the company to process the entire claim of the insured.
Tata AIG’s counsel submitted that the ombudsman had failed to consider that the terms of the policy precluded the insured from making any claim in respect of the medical expenses incurred in India.
The Ombudsman has wrongly passed the award by recording reason that since the company is ready to pay Overseas medical expenses, it is concluded that permission is granted as treatment in India is in continuation from the treatment from abroad, Tata AIG contended.
However, the insured contended that since he became so ill, he had to abort his tour and return to India, hence he is entitled to seek recovery of the expenses.
“Merely, because the Insurer has agreed to pay the overseas medical expenses, it cannot be held that the Insurer is liable for the medical treatment taken up in India,” Justice RM Joshi said on August 14
Also, there is no finding to show how the treatment in India is in continuation of the treatment abroad when the insured claimed he was treated for vertigo. “Admittedly, the Insured has been treated in India not for vertigo but for other disease… Moreover, in absence of any term of Policy or any acceptance of liability in advance by Insurer, no such liability can be fastened on Insurer,” the judge added.
