Hyderabad Ombudsman Centre
Case No. : G 11.007.0132
P. Rangaraj
Vs
Tata AIG General Insurance Co.Ltd.
Sri B. Rangaraj Parthasarathy, who retired from ONGC in 1991, had taken a Travel Guard Insurance Plan before leaving for the US during August 2005 for a period of 180 days. While he was in the US, during November 2005 he had an acute infection of gallbladder (Acute Cholecystitis) and was admitted at a private hospital on 14.11.2005.
He was then operated for removal of Gallbladder on an emergency basis. The insurer repudiated the claim on 28.02.2006 under Exclusion No.2 “the policy does not provide benefit for any expenses incurred directly or indirectly in respect of any pre-existing condition or any complication arising from it”. The insured contended that rejection of claim by the insurance company is not justified as acute cholecystitis develops due to bacterial infection which may be blood borne and not related to GallStones.
The issue before the forum was whether the insurers were right in rejecting the present claim. Having perused the test reports of the hospital, the treatment papers from USA and the medical opinions submitted supporting the respective contentions; the forum found the insurers were correct in the interpretation of the policy wordings and the consequent rejection of the claim. The complaint is dismissed.
