The Times of India
KOCHI: An insurance company cannot deny a claim by saying headache was pre-existing, said insurance ombudsman. It added that no one could make any claim if that had been the case. The order was issued after considering a complaint lodged by a woman from Thiruvananthapuram, who was denied claim for the money she spent on treatment in a foreign country.
On her visit to the US in March last year, she was admitted to a hospital following headache due to climate change. She spent $315 (Rs 18,000) for two hours of treatment. She told the doctor that she often suffered headaches, which was entered in the medical report.
Before leaving for US, she had availed an overseas travel insurance policy from the New India Insurance Company. When she approached the insurer later, the claim was denied by the company saying the headache was pre-existent citing the medical report. Insurance ombudsman P K Vijayakumar said, "The third party administrator (TPA) who settles the dispute between insurance company and the consumer said headache was a chronic condition and cannot pay the claim. If that was the case, nobody in India could avail insurance". The ombudsman ordered the company to pay the claim.
" TPA was misinterpreting the fact. It was bizarre that the company rejected my claim and forced me to approach the ombudsman,'' said the woman.
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