Mumbai: A district consumer commission has directed an insurance firm to pay ₹9.70 lakh claim money that it rejected stating that the treatment of the complainant was for pre-existing ailment.
The commission relied on the complainant’s Mumbai-based physician’s letter and hospital bills to give the claim money. The complainant had taken a travel insurance cover and fell on a trip to Dubai.
The order dated January 27 was passed by SS Mhatre and MP Kasar, members of District Consumer Disputes Redressal Commission, Central Mumbai. The order was given on a complaint by Lajwanti Daulat Ramsinghani (represented by four legal heirs after her death) against Tata AIG General Insurance Company Limited and others.
Victim falls down staircase in Dubai
Ramsinghani had taken a ‘Travel Guard Senior’ insurance policy for 90 days beginning February 2, 2017, that was applicable in all countries except America. For this she paid a premium of ₹13,441. She took a business-cum-leisure trip to Dubai during the policy period. In Dubai, she fell from a staircase and was admitted into Mediclinic City Hospital, where she was treated and presented with a bill of 15,851 UAE Dirhams. After 10 days, she again had problems so she got admitted to Harley International Medical Clinic where she spent three days.
When things did not improve, she moved back to the earlier hospital. Eventually a total bill of 76,548.62 dirhams, or ₹13.41 lakh, was raised. Tata rejected the claim citing ‘pre-existing ailment condition’ as the reason in April 2017.
Commission finds insurance company at fault
Tata also stated that the letter of the doctor attached for the claim was not of the treating doctor and that it had given ₹97,800 to the complainant.
The commission stated that as per bills and records, the complainant had proved her case and that the insurance firm committed deficiency in service by not giving the claim money. The commission directed ₹9.32 lakh be given as per non-standardised basis without interest as it was not sought in the initial prayers.
