Polyps and policies

Luca was overseas when his wife, Anna, was diagnosed with a uterine polyp. Anna’s gynaecologist recommended surgery, which was scheduled to take place three days before Luca was due to return to New Zealand. Luca decided to cut short his trip and return to New Zealand early to support Anna, and to care for their children while she recovered.

Luca made a claim to his travel insurer for the costs of rebooking his flights. The insurer requested Anna’s medical records. Anna had not been to a GP for 25 years, so she had no records other than evidence of surgeries for endometriosis almost 20 years earlier.

The insurer declined Luca’s claim. It said uterine polyps are not ‘life threatening’, and so were not covered by the policy. It also said, because there were no other records, it could not be satisfied that Anna’s uterine polyp was not linked with her prior endometriosis (and therefore a pre-existing medical condition).

 

Dispute

Luca complained to FSCL. He said that any surgery has associated risks, and there was a chance Anna’s surgery could have been life-threatening. He also questioned how endometriosis almost 20 years ago could be relevant to his claim.

 

Review

We reviewed the terms of the travel insurance policy, which was the contract between Luca and the insurer. We noted that the policy covered cancellation costs where a close relative is diagnosed with a ‘life threatening sickness’. Even though Luca’s decision to cut short his trip was understandable, we formed the preliminary view that Anna’s polyp was not life threatening, which we noted is a very high threshold, so Luca’s insurance policy did not cover his cancellation expenses.

 

Resolution

Luca made no further submissions and we closed our file.

 

Insights for consumers

The insurance policy is a legally binding contract between you and the insurer. When assessing your claim, the insurer is entitled to apply the wording of the policy, even if you incurred the costs for very understandable reasons.

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