Going abroad, many travelers enter into contracts of insurance in case of health problems. Medical care abroad can be associated with significant monetary expenditure.
It happens that unscrupulous insurance companies, sometimes on false pretexts, refuse to pay for treatment of the insured person. In such situations, to seek insurance payment is possible only in a judicial order.
24 August 2016, my principal - D., made his wife an insurance contract with LLC "Zetta Insurance". According to it, the company has issued an insurance policy traveler TRV No. 0008396227.
08 September 2016 the wife of the principal – K., who was in the US, appeared sharp pain in the lower abdomen. D. on the phone reported the incident to the insurance company, and, with the approval of the company representative, called an Ambulance.
K. was hospitalized. For medical assistance, in coordination with the "Zetta Insurance", she paid 418,99 USD. The company assured the Trustee that the full amount will pay for treatment of his wife.
However, its promises and obligations, OOO "Zetta Insurance" is not fulfilled, referring to paragraph 4.6.12 of the Rules of insurance, which implies that any complications of the menstrual cycle are not insured.
Me, a seasoned civil litigator, has experience in disputes with insurance companies.
Having carefully considered the medical records, I have not found it diagnosis is a complication of the menstrual cycle. In the interests of the Trustee prepared a statement of claim on the recognition event insurance event and the recovery of insurance compensation.
My arguments were supported by reference to the norms of the civil code regulating liabilities of the insurer, Rules of insurance of citizens leaving abroad.
In addition, I had prepared the claim, confirmed by the Law on protection of consumer rights, the Decision of the Supreme Court on disputes on protection of consumer rights. According to these standards from the defendant to the plaintiff is charged a penalty for failure to meet requirements on a voluntary basis.
The judge agreed with my claims and arguments supporting them.
06 June 2018 the magistrate court plot №210 of the Filyovsky Park district of Moscow on the consideration of civil case No. 2-558/18, a claim D. to "Zetta Insurance", granted. The plaintiff recovered more than 30 thousand rubles, the case was considered insurance.
Upon failure of the insurer to meet its obligations, contact the lawyers in civil cases, arubotaim successful experience of dispute resolution in such cases.