your insurance policy before going abroad
[Publisehd in Rediff Business
means peace of mind," is a claim made by the insurance
companies. But it doesn't always work that way and the insurance
companies often try to wriggle out of their liabilities.
always prudent to read the fine print before signing on the
dotted line - especially if you're planning to opt for an
overseas MediClaim policy. An overseas MediClaim policy is
supposed to take care of all medical needs when the policyholder
for instance, the case of S J Lobo, who had obtained such
a policy for the period April 2, 1997, to September 28, 1997,
from Oriental Insurance before leaving for the US.
Lobo had to undergo angioplasty surgery with a stent implantation
while he was travelling. Consequently, Lobo informed the US
hospital that the bill would be paid directly by the insurance
company as per the MediClaim policy.
his return, Lobo submitted a claim to Oriental Insurance with
the supporting documents for all the expenses incurred on
treatment in the US.
however, returned the claim documents with instructions that
the policy holder should approach Mercury International, Brighton,
UK, for the settlement of his claim. Oriental refused to entertain
filed a consumer complaint with the Karnataka State Consumer
Disputes Redressal Commission, Bangalore, asking that the
insurance company pay him $40,000, or Rs 1.6 million, as reimbursement
of medical expenses incurred by him.
company filed a reply in which it rejected its liability to
honour the medical claim on the ground that it was clearly
mentioned on Page 15 of the policy that claims in excess of
$500 should be submitted to Mercury International at their
UK address and they alone were responsible for settling overseas
agreed to abide by the terms and conditions, as stipulated
in the policy documents, the claimant could not make the Indian
company liable in any way, it pleaded.
commission dismissed the complaint filed by Lobo. In its order,
the commission observed that, "what we see from the material
placed on record is that the complainant has blissfully closed
his eyes on all specific stipulations contained in the policy
and has come out of slumber only when he reached back India."
Kundra's experience was worse. She had taken an overseas MediClaim
insurance policy, again from Oriental, before leaving for
the US. When she fell sick she tried to contact Mercury Insurance
in the US on the telephone number given in the insurance policy.
failed to establish contact with Mercury Insurance and as
she did not have enough money to afford the treatment, she
cut short her trip and returned home.
return, Kundra found that Mercury's phone number in the US
- as mentioned in the policy - was incorrect. Kundra filed
a case before the MRTP Commission, but was just awarded Rs
5,000 for her inconvenience.
State Commission - in its judgement in Lobo's case - went
to the extent of observing that "in the scheme of insurance
of whatever nature, the terms and conditions issued along
with and forming part of the policy is paramount and invariably
such conditions may contain terms which have no place in a
policy and the terms and conditions appended thereto in fact
constitute the whole gamut of contract between the parties
entered into on the principles of uberrima fides and hence
it cannot be said by any semblance of logic that any one or
more of the conditions stipulated therein cannot be enforced
simply because a parallel condition is absent in the proposal
cases mentioned here should be an eye-opener for anyone taking
out a MediClaim policy. There are hundreds of escape clauses
for the insurance companies and it's better to read them before
falling sick rather than the other way round.
is an advocate and the editor of Consumer Protection and Trade
traveling to the US and Canada, check
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