Chennai Ombudsman Centre
Case No. : 11.07.1350/2006-2007
Smt. Baghyalakshmi
Vs
TATA AIG Gen. Ins. Co. Ltd
The Complainant Smt V. Baghyalakshmi was covered under Travel Guard policy with M/s TATA AIG General Insurance Co. Ltd., for her visit to the USA for the period from 22.03.2006 to 17.09.2006. She fell sick in the USA and took treatment for the same, which cost her US$ 132.69. She preferred a claim with the insurer for US$ 132.69, but the insurer admitted only US$ 32.69 and disallowed US$ 100 for the reason of deductible.
She represented to the insurer that the reduction of US$ 100 is arbitrary, unreasonable and disproportionate. The Insurer did not consider her representation. The Insurer contended that they have clearly mentioned the deductibles of USD 100 on the face of the policy and irrespective of the claim amount the deductible is applicable. The Insurer also contended that since they cover high risk and face more claims under OMP policy, they have made the deductibles as 100 USD.
The Forum perused the documents and observed that he had preferred a claim under the benefit of Accident & Sickness Medical expenses and the insurer also admitted the liability under the said benefit. The insured is not justified in objecting to the same at the time of settlement of his claim. Hence, the complaint was dismissed.
