US Trip Turns Costly After Insurer Rejects 62-Year-Old Woman’s Medical Claim; Consumer Commission Orders Payout

A holiday in the United States (US) became a medical and financial strain for a 62-year-old woman after she injured a toenail while closing a door during household work. She sought treatment at a hospital and bought medicines, paying the expenses herself. When she returned to India and asked her travel insurer to reimburse the bills, the company refused the claim.

The Chandigarh District Consumer Disputes Redressal Commission has now directed the insurer to pay USD 944.61, equivalent to more than Rs 89,000, for expenses it found were linked to her treatment during the trip. It also ordered the company to pay Rs 30,000 as compensation for mental agony and harassment, along with litigation costs.

The commission held that the insurer’s refusal amounted to deficiency in service and an unfair trade practice. It did not find the online insurance broker at fault.

Injury Led To Multiple Hospital Visits

The woman had bought an international travel insurance plan through an online insurance broking service. The policy was valid from February 17 to April 9 and covered her medical expenses for illness or injury abroad up to USD 500,000. She travelled to the US on February 18, according to a recent report by The Indian Express.

On March 5, she injured her toenail while closing a door at home, according to her complaint. As the pain continued, she bought medicines from a local pharmacy and visited the emergency department at Franciscan Hospital several times. Her doctor later advised her to consult a surgeon.

The woman said she had paid USD 1,224.61 in total for the treatment and related expenses. With her funds exhausted, she brought forward her return journey, travelling back to India on March 24 instead of April 1 and paying extra to change her flight.

After returning, she submitted her medical bills and sought reimbursement from the insurer. She said repeated requests did not result in payment, prompting her to approach the consumer commission.

The insurer argued it could not accept the claim because she submitted bills without the medical treatment papers needed to establish the injury. The broker said it had only helped her buy the policy and that claims were decided by the insurer.

Commission Finds Insurer Withheld Covered Expenses

The commission noted that the policy was active when the injury occurred and covered medical expenses arising from illness or injury during the trip. It also considered that the woman had received treatment at the hospital and purchased medicines from a pharmacy.

The insurer’s argument about missing treatment papers did not persuade the commission. It said the policy terms required the company to cover reasonable and customary medical charges incurred to relieve acute pain resulting from an accidental injury.

Of the USD 1,224.61 claimed, the commission found that bills amounting to USD 944.61 related directly to treatment during the trip and had been wrongly withheld. It ordered the insurer to reimburse that amount, pay Rs 30,000 in compensation and meet litigation costs.

For travellers, the case underlines the importance of checking what a policy covers and keeping records when seeking treatment abroad. Keep the bills, prescriptions, and hospital records from your treatment abroad. Your insurer may ask for them when you file a claim. If you need treatment abroad, call the insurer’s assistance number as soon as you can, especially if you are admitted to hospital. Follow its instructions for filing a claim.

The commission did not hold the broker responsible. It had helped the woman buy the policy; the insurer was responsible for deciding her claim.

FAQs

What did the Chandigarh consumer commission order the insurer to pay?
It directed the insurer to reimburse USD 944.61 in medical expenses, pay Rs 30,000 as compensation, and meet litigation costs.

Why had the insurer rejected the woman’s claim?
The insurer said she had submitted medical bills without treatment papers to establish her injury. The commission did not accept this as a reason to withhold the covered expenses.

What documents should travellers keep when they receive medical treatment abroad?
Keep medical bills, prescriptions, and hospital records. The insurer may ask for these when assessing a claim.