Serious illness overseas

Monica and Ian were overseas when Monica became suddenly unwell. She deteriorated rapidly and the doctors seemed unsure of the cause, although suspected Monica may have cancer. Ian contacted their travel insurer.

The travel insurer checked with Monica’s doctor, who agreed the best thing would be for Monica to return home. Monica was so unwell that she required a flight nurse to accompany her. The day before travel, the flight nurse and Monica’s doctor agreed she was fit to fly, but overnight Monica deteriorated. When the flight nurse arrived at the hospital the next morning, she said Monica was too sick to travel.

The travel insurer contacted Monica’s doctor, who confirmed again that Monica was fit to fly, and a different flight nurse travelled to accompany Monica home. Monica was discharged from the hospital into the flight nurse’s care and had an extremely uncomfortable trip home to New Zealand.

On arriving back in New Zealand, an air ambulance took Monica to the regional hospital near her home. By the time Monica reached the regional hospital she was so sick that she had to be transferred again by air ambulance to a bigger hospital.

Monica underwent successful surgery, but the doctor said Monica was lucky to be alive. In the New Zealand doctor’s opinion, she should never have been transferred and should have had surgery overseas before travel.

Ian complained to the insurer that it was more focused on saving money, by transferring Monica back to New Zealand for treatment, than saving her life.

The insurer disagreed and Ian referred the complaint to FSCL.

 

Dispute

Ian provided the letter from the New Zealand doctor and the discharge summary he was given before leaving the overseas hospital. The discharge summary stated: ‘discharged against advice’. Ian said if Monica had received surgery overseas, they would have avoided a considerable amount of distress on the trip home, and afterwards while waiting for Monica to be transferred to a larger hospital.

The insurer strongly refuted that it was motivated by money when evacuating Monica home. Monica’s care and transporting her home cost more than $70,000.

The overseas doctor thought Monica might have cancer, and if this was the case, the best place for Monica was her home country. The overseas doctor had confirmed that Monica was fit to fly and, when arranging the travel home, the insurer relied strongly on his advice. After the first flight nurse declined to take Monica, the insurer again discussed her travel home with the overseas doctor and arranged for a very senior nurse to travel to care for Monica on her flight home.

 

Review

We reviewed the insurer’s extensive file and were satisfied there was no evidence that the insurer’s decision to transfer Monica home was motivated by money. There was also no evidence that the insurer knowingly risked Monica’s life. Rather, it seemed that the insurer was focused on bringing Monica home, a goal that both Ian and Monica had originally wanted. We could see that the insurer was working very hard behind the scenes to make the complicated arrangements to bring Monica home safely.

 

We were also mindful that we review complaints with the benefit of hindsight. As it transpired Monica did not have cancer, but an infection that could have been treated overseas. Unfortunately, neither the overseas doctor nor the insurer knew this at the time.

 

However, we were very concerned that the insurer appeared to have disregarded the first flight nurse’s advice and that the second flight nurse appeared to be unaware that the discharge papers stated: ‘discharged against advice’. The discharge papers were not on the insurer’s file and the insurer was completely unaware that the document even existed. The insurer was adamant that if the second flight nurse had seen the discharge papers, she would not have left the hospital with Monica.

 

We acknowledged that the insurer had to base its decision on the overseas doctor’s advice, that Monica was fit to fly, but we wondered whether it had asked the right question because it appeared so focused on returning Monica home. The insurer had not asked the doctor for his medical opinion of what would have been best for Monica. Instead the insurer asked if she was fit to fly.

 

Resolution

We concluded that, in the light of the information the insurer had at the time, the decision to fly Monica home was a decision reasonably available to the insurer to make. However, we considered that given the extreme stress Monica and Ian had experienced, compensation of $1,000 was appropriate.

Monica, Ian and the insurer accepted our view and the case was resolved on this basis.

 

Insights for consumers

Although it seemed to Ian and Monica that their insurer might not have made the right decision, it had little choice but to rely on the overseas doctor’s advice. All the evidence on the file indicated the tremendous amount of work and care from the insurer’s staff to bring Monica home.

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