RGC 186/1437
This case involved an insurance company's failure to pay for medical treatment under a health insurance policy outside Saudi Arabia. There had been a failure to prove it was emergency treatment and complied with the policy.
Background
A claimant, a Jordanian national, holding a resident identity number, filed a claim with the General Secretariat of the Committees, which was registered on a specified date. The claimant was covered under a medical insurance policy, valid for a specified period.
During his stay in the Hashemite Kingdom of Jordan, the claimant was admitted to hospital due to severe stomach pain. He underwent an exploratory abdominal procedure and adhesion removal surgery, and was discharged as confirmed by the medical report issued by the hospital. The claimant incurred medical expenses, according to the invoices submitted. He subsequently requested reimbursement from the defendant.
Upon being contacted by the General Secretariat of the Committees, the defendant responded, stating that the claim was not covered under the insurance policy. The insurance schedule specified that coverage was limited to the Kingdom of Saudi Arabia.