Travel insurer says no to toenail injury treatment of 62-year-old woman injured during US visit; court orders company to reimburse over Rs 89,000 for treatment in United States and pay Rs 30,000 as compensation for mental harassment

A 62-year-old woman has won a consumer case against her travel insurer after it refused to reimburse her medical expenses for a toenail injury sustained during a visit to the US. The Chandigarh District Consumer Disputes Redressal Commission passed the order on October 23, holding the insurer guilty of deficiency in service and unfair trade practice, reported TOI.

Why did the insurance company reject her claim?

After returning to India, she submitted her medical bills for reimbursement. However, the insurer rejected her claim, arguing that the bills were insufficient without supporting medical records.

The online insurance broker also contested the complaint, maintaining that its role was limited to facilitating the policy purchase and that claim settlement decisions rested with the insurer.

How did the woman sustain the injury?

The woman travelled to the US on February 18 with an international travel insurance policy valid from February 17 to April 9. On March 5, she injured her toenail while closing a door during household work. When the pain persisted, she purchased medicines from a local pharmacy and visited the emergency department of Franciscan Hospital several times.

She paid for the treatment herself and later sought reimbursement from the insurer. A doctor subsequently advised her to consult a surgeon. However, due to dwindling funds, she decided to return to India earlier than planned, rescheduling her flight from April 1 to March 24, reported TOI.

What did the consumer commission observe?

The commission noted that the policy provided medical coverage of up to USD 500,000 for illnesses or injuries sustained during the insured trip. It rejected the insurer's argument, observing that the policy covered reasonable and customary medical expenses incurred to relieve acute pain resulting from accidental injuries.

Of the USD 1,224.61 claimed by the woman, the commission found USD 944.61 (more than Rs 89,000) eligible for reimbursement. It held the insurer guilty of wrongly withholding the eligible claim amount but absolved the online insurance broker of liability.

How much compensation will the woman receive?

The insurer has been directed to:

• Reimburse USD 944.61 (more than Rs 89,000) towards medical expenses.
• Pay Rs 30,000 as compensation for mental agony and harassment.
• Bear the litigation costs.