President directs reimbursement of health insurance claim to citizen
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ISLAMABAD: President Dr Arif Alvi has upheld decision of Federal Insurance Ombudsman (FIO) directing an insurance company to reimburse full health insurance amount of 57,172 Australian Dollars (AUD) to citizen, who had been denied insured amount on flimsy grounds, within 30 days.
Complainant (Fahad Mahmood) had obtained Worldwide Travel Insurance Policy from company (United Insurance Company of Pakistan Ltd) for his father to travel to Australia with sum assured of $50,000 for medical expenses and hospitalisation abroad, President Secretariat Press Wing said in press release.
During his stay in Australia, his father was admitted to hospitals twice and was treated for few days. He filed health insurance claim but company only honoured claim for his father’s first admission to hospital in Australia. Second admission claim was denied on ground that his father was admitted for second time due to pre-existing ailments (chronic kidney disease, chronic heart failure, diabetes, benign prostate hypertrophy and hypertension) which he did not disclose at time of obtaining policy from company.
Feeling aggrieved, complainant approached FIO for relief, which passed order in his favour. Subsequently, company filed representation with President against FIO’s order, which was rejected.
President held that FIO had rightly observed that “Business of insurance obliges company to ensure protection of interests of insurance policyholders.”
He observed that company accepted first admission claim without any objection but it took plea of pre-existing ailment while repudiating second admission claim unjustifiably without producing cogent material to corroborate its stance. He observed that repudiation of second admission claim on flimsy ground, while honouring first admission claim, constituted maladministration on part of company, which was unjust, unreasonable and based on irrelevant grounds.
Published in The Daily National Courier, April, 19 2023
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