Claim is payable due to medical repatriation

Mayank Tody had secured admission to a college in Britain for higher studies. Prior to leaving, he took ICICI Lombard's 'Globetrotter Overseas Individual Student Travel Insurance Policy', which covered various risks when travelling abroad for studies.

Tody suddenly fell ill and the college authorities got him admitted to North West London Hospitals. The diagnosis was typhoid, diarrhoea, clotting abnormality and fever (apparently septic). He was hospitalised from January 27 to February 3, 2005. At the time of discharge, he was still feeling unwell and suffering from fatigue. So, he was medically advised not to go to college but to return to India for recuperation, recorded in the discharge card.

Since Tody was young and alone in a foreign land, his father flew down to London to be with him and escort him back to India, in line with the medical advice. His condition was reviewed on February 10, 2005, when his progress was found to be good, though he had complaints of pain in the feet and small joints of hands, and fatigue, with abdominal fullness. A week later, he was found to have had a relapse of typhoid with anaemia. Due to the illness, Tody had to abandon further studies. Tody later lodged a claim with ICICI for £3,500 towards study interruption and for £1,545.99 towards the compassionate visit of his father. No claim was made for medical expenses, since students in the UK are treated free of cost. The total claim, thus, was £5,045.99, equivalent to Rs 4.14 lakh (calculated at £1 = Rs 82). On receipt of the claim, ICICI asked Tody to clarify about refund of fees. The college gave a written clarification that even though the studies were discontinued due to illness, the fees were non-refundable.

The claim for study interruption was repudiated on the ground that it is not payable unless hospitalisation is for more than one month. The claim for compassionate visit, though well within the insurance limit of £7,500, was rejected as prior permission from ICICI had not been taken. Another reason for rejection was that the claim had not been filed within the prescribed period and there had been a delay in lodging it.

Tody approached the insurance ombudsman, who upheld the repudiation without adverting to the provisions of the policy. Ultimately, Tody, through the Consumers Welfare Association, filed a consumer complaint before the South Mumbai District Forum. The Forum observed that the claim for study interruption was payable if any one of the three conditions prescribed under the policy was fulfilled. One of the conditions provides for claim due to medical repatriation. Yet, conveniently ignoring this stipulation, the claim had been wrongly rejected. The Forum held that £3,500 for study interruption would be payable.

Regarding the claim for compassionate visit, the Forum observed that the policy provides for such a visit after obtaining permission only in case medical repatriation is not possible. In Tody's case, medical repatriation was possible and in fact he had been repatriated. Hence the Forum ruled that the claim for compassionate visit was misconceived and its rejection by ICICI was proper. On the objection regarding failure to file the claim in time, the Forum observed that according to the policy the claim had to be lodged within one month of completion of treatment, not within one month of discharge as contended by ICICI. A sick person cannot be expected to file the claim immediately or within one month of his hospitalisation. No such objection had even been raised in the repudiation letter. The raising of this objection for the first time in the reply before the Forum was held to be devoid of substance.

The author is a consumer activist