This story can happen to anyone who travels abroad for tourism and does not refrain from possible accidents. To celebrate the birthday, on October 5-15, 2015, one of the citizens of Armenia travels to Paris, France, as a tourist, with permanent second-class disabled husband. When getting a visa, as required by the French Embassy, a certificate on “Support Insurance AA II 071637” by the name of the wide was taken from ARMENIA INSURANCE” Insurance Company.
As the representative of the claimant’s wife, attorney Gagik Khachatryan, informed during the completed civil lawsuit at the court of general jurisdiction of Kentron and Nork-Marash administrative district, on October 9, walking on the street, the claimant’s leg was twisted. And since the woman cannot walk and the husband could not leave her alone on the street, they had to turn to an orthopedic doctor in one of the hospitals in Paris for consultation. “The doctor examined the foot, knee, hip and recommended to have an MRI of her spine and hip area after which he gave a referral to the woman to a corresponding hospital in Paris. In 12.10.2015 and in 13.10.2015, the claimant received some injections for the MRI examination, as a result of medical intervention and injections, the pain around the hip are gone. Until now, there is no pain. The claimant has paid 1900 euros for medical services,” – said Gagik Khachatryan in a conversation with “Aravot”.
After returning to Yerevan, on October 22, the claimant has submitted a claim to the insurance company for the reimbursement in the amount of EUR 1900 but was rejected by their conclusion. Incidentally, the certificate of the insurance company shown in the photos reveals that bearing the responsibility for the lost luggage was primary. In the case of insured luggage, the Armenian telephone number +374 10-04-04 was mentioned to call in the case of an accident covered by the insurance, but no Armenian telephone number is mentioned for the case of accidents envisaged by the insurance certificate during the traveling. This is in the case when a certificate is issued by the insurance company, the state language of which according to the RA Law “On the Language” is Armenian.
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The reverse side of the certificate issued by the insurance company gives telephone numbers of 15 countries which you can call in the case of accidents during your travel in the case of having an accident covered by the insurance policy which however does not list any French telephone number. There was another problem too: the insured has not immediately called the insurance company because according to G. Khachatryan, “when called the alleged number, to fulfill the requirements of the clauses 13.1.1, 13.1.2, 13.1.3 and 13.1.4, the person should at least be able to describe the required necessary information at least at the conversational level which she could not do it because of not knowing any foreign language.”
At the court, the insured presented the documents of the examination carried out by Doctor Christoph Byughi and medical procedures prescribed by the doctor at the orthopedic and surgery medical facility at the Dieu Shazel of Paris, Street No 21. The respondent’s representative, Gagik Harutyunyan, had sent their objections to the court. According to the insurance company, by the insurance policy issued to the claimant, in the case of an accident under the insurance policy during the traveling, the insured must immediately call either to AXA or AP servicing companies and report on the incident. Gagik Khachatryan had submitted an application to the insurance company to receive an insurance reimbursement.
Meanwhile, the claimant has not called to AXA or AP Assistance organizations for the accident. The company has reimbursed seventeen thousand AMD to the insured for the translation of the documents. The medical documents were translated and ratified by the notary agency. Note that the English language text was given to the Armenian tourist and no unclear question was raised while the Armenian translation of medical documents was required from the tourist. The insurance company has cited the cases when the person can call to them directly: sudden health disorder and deterioration of normal function of the body that were caused by internal or external stimuli and require immediate and given type of medical care, moreover, this deterioration must be a manifestation of a non-chronic disease by its nature or life-threatening escalation of chronic disease, incidentally, such complaints must appear first time during the terms of insurance and be in the territory of insurance. Also, an acute disorder of blood circulation in the brain, heart attack, coronary heart disease and its consequences and escalations, and coma. “The insured has not fulfilled her obligations defined by the rules and has not called to AXA or AP Assistance organizations, and has not agreed medical and related costs with the insurer or the Servicing company,” – objected the company. Incidentally, a doctor-expert was involved by the Financial System Mediator during the examination of the case whose conclusion was placed in the bases of legal assessment of the insurance company and the court as an evidence. Whereas during the judicial proceedings, it was not examined as an evidence.
According to this expert, about which the claimant had doubts about his professionalism, “there is no record in any medical document about the situation caused as a result of any traumatic injury or leg twisting but only in the words of the insured about the leg twisting. Given the above-mentioned, there are no records at all about the reasoned complaint on the left leg and about the occurrence of any trauma as well as clearly indicated diagnosis which according to the clause 14.2.2. of the regulation is considered the basis of refusal”. The claiment’s representative intends to appeal the refusal verdict of the judge of the Court of First Instance, H. Zargaryan, at the civil Appeal court, “By the rules of the insurance company, the requirement matches the insurance accident happened to my client which is envisaged by clause 9.2.1 of the rules on the “Assistance to insurance policy.” The “Armenian Insurance” company does not accept it as the purpose, in my opinion, is to avoid making the insurance payment.”
Ruzan MINASYAN
