Travel insurer pays 10% for heart treatment in US, 73-year-old woman wins Rs 86 lakh

A Haryana District Consumer Commission recently ruled in favor of a 73-year-old woman who received insufficient compensation for heart treatment in the US. The insurance company had only paid 9,900 USD (around Rs 9 lakh) out of a total sum assured of 100,000 USD, or 10%. The commission found that the insurer improperly cited the woman's diabetes as a contributing factor to her cardiac condition, despite her having disclosed this pre-existing disease when purchasing the travel insurance policy.

The commission awarded her Rs 86,000 in compensation for mental distress, harassment, and legal fees. The insurer argued that the policy covered only 10% of the sum insured for cardiac events, but the commission held that this clause could not unilaterally reduce the insured's entitlement to the full sum. The case highlights the importance of insurers upholding their contractual obligations without unfairly restricting coverage due to disclosed pre-existing conditions.