HYDERABAD: A retired bank worker won a significant case with the Insurance Ombudsman against National Insurance Company Ltd. The company must now pay for dental surgery and a root canal. This case, supported by the Association of Retired IOB’s Employees (ARISE), could influence future claims.
The insurance claim was for Rs. 70,847. Initially, National Insurance refused to pay, saying the dental work was “cosmetic surgery.” The claim was for the spouse of K Durga Sambasiva Rao, an ARISE member, under a Rs 4 lakh Family Floater Insurance Policy from the Indian Banks’ Association (IBA) for retired employees.
ARISE argued the claim was valid under policy clause 2.12, covering “dental treatment” like exams, fillings, crowns, and surgeries. They worked for two years to push this point.
Last week, the Insurance Ombudsman in Hyderabad sided with ARISE after reviewing both sides. The decision overturned the insurance company’s earlier denial, agreeing with ARISE’s view of the policy.
CSR Anjaneyulu, ARISE’s deputy general secretary, stated, “This is a landmark decision in dental surgery claims under the IBA policy.” He believes it will help others with genuine claims. The National Insurance Company must pay the claim within 30 days.
