Hyderabad Ombudsman Centre
Case No. : G 11.012.0170
Shri G L.L. Aparanji
Vs
ICICI Lombard Gen Ins. Co.Ltd.
Smt. G.L.L. Aparanji (G.Lavanya), was insured under the Globetrotter Overseas Individual travel Insurance policy for the period 22.10.2005 to 18.02.2006. The policy covered expenses incurred by the insured for availing immediate medical assistance on account of any injury or illness sustained or contracted while abroad.
She was admitted to Minnesota Heart Clinic on 24.01.2006 with chief complaints of palpitations. She incurred an expenditure of US$ 3440.20 towards hospitalisation expenses. She lodged her claim with the insurers, who rejected the claim on the ground that “the insured’s medical condition is the result of the pre-existing condition of palpitations and tachycardia.”
It appears the insurers have not applied their mind while arriving at the conclusion that the disease was pre-existing. They quote the treating doctor noting that the patient had several episodes of palpitations on various dates during her stay abroad. This observation clearly reveals that the doctor himself is not sure whether she has mitral valve prolapse and recommended further diagnostic tests to rule out the existence of the same.
The forum directed to honour, process and pay the claim as per terms and conditions of the policy.
