Chandigarh Ombudsman Centre
Case No. : GIC/173/ICICI/11/07
Madhu Banati
Vs
ICICI Lombard
Smt. Madhu Banati had taken an overseas travel policy on December 04 to visit her unmarried daughter working in Michigan, USA. During her travel to west coast USA, she developed an ailment in her right eye due to inflammation which was noticed on 31.1.05. M/s Coris America, Florida was contacted for servicing under the policy and her claim was registered. She informed the insurer and M/s Coris America about the treatment through emails and phone calls.
She was assured that her claim shall be reimbursed. On arrival back in India in May’05 she filed a claim at BO Chandigarh for reimbursement of expenses incurred on treatment undergone by her. The claim was rejected vide letter dated 23.9.05 on the plea that the disease was pre-existing. She contended that she never suffered from any ailment in her right eye. The damage to her left eye occurred in the form of reduced vision which was irreversible.
The insurer informed that Associated Retinal Consultants Livonia MI had been consulted and they mentioned that the complainant had pre-existing disease in the left eye. Based on this information the claim had been repudiated.
Held that the treatment required by the complainant was of emergent nature in the USA and required immediate medical attention. It was ordered that an admissible amount of claim be paid to the complainant.
