He pays 10,000 dirhams for treatment and demands 60,000 in insurance Gulf newspaper
Abu Dhabi: Aya al-Deeb
The Abu Dhabi Court of First Instance dismissed a lawsuit filed by a man, in which he demanded that an insurance company pay him 60,000 dirhams, of which 10,000 dirhams he paid as treatment for himself after suffering a stroke in his left foot, and 50,000 dirhams as compensation for its delay in paying the costs of his treatment, as the court confirmed that The man has a sick history of strokes, and when he contracted with the insurance company, he denied having any medical condition that required care.
The case papers state that the complainant entered the hospital as a result of a blockage of a vessel in the thigh in the left foot (stroke), and that after receiving treatment, the hospital sent the claim to the insurance company, which refused to pay because the disease was old and the complainant did not declare it at the time of insurance, which forced him to pay the amount to the hospital.
In his lawsuit, the complaining patient demanded that the decision issued by the Insurance Dispute Resolution and Settlement Committee, which rejected his complaint against the insurance company, be annulled and oblige the insurance company to pay him 10 thousand dirhams for his treatment costs, and 50 thousand dirhams in compensation as a result of the insurance company’s delay in the amount of treatment, and to assign an insurance expert to state his rights under The insurance policy, and he also demanded that the insurance company be obligated to pay fees, expenses, and attorney’s fees.
The complainant confirmed that the Insurance Dispute Resolution and Settlement Committee rejected his complaint based on his inability to attach a report from an insurance consultant at the Central Bank of the United Arab Emirates to indicate the entitlement of his claims, and that he asked the committee to appoint an expert and confirmed his willingness to pay the prescribed fees for that, but the committee did not consider that.
The complainant’s lawyer confirmed that the insurance company had to ascertain the health status of the complainant at the time of the contract, so that he would be obligated to pay the amount of the insurance claim, and the judge supervising the case decided to assign an insurance expert.
As for the court, it indicated that according to the expert’s report, the insurance company, when asking the patient about any chronic or previous illness or medical condition that requires medical attention soon or later, should disclose it regarding any of the applicants? The complainant replied with a negative “No”, despite the fact that the expert concluded that there is a record of the same medical condition that the complainant suffers from before the validity date of the medical insurance contract with the insurance company, where he suffered a stroke for the fourth time.
And she confirmed that the complainant did not inform the insurance company about his condition according to the rules, and then the claim of the complainant is not covered by insurance, and then the court ruled to support the decision of the Insurance Disputes Committee, and oblige the complainant to pay fees, expenses, and in return for attorney’s fees.