Case Studies

Our case notes show how we deal with the many different issues that arise in our case investigations. The case notes aim to provide consumers and participants with guidance as to the approach we are likely to take in a particular type of case or highlight some of the many different ways in which a complaint can be resolved.

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Title Year Case summary
“A traumatic trauma claim” 2016

In 2015 Hans has a trauma claim paid after he suffered strokes. However, Hans considered he could have received further benefits under his policy if his adviser had provided him better advice. Was the advice process flawed, causing Hans a financial loss?

“I’ve gotta get out of this place, if it’s the last thing I ever do.” 2016

Jack injures his knee in Cambodia and suffers complications after surgery. Does Jack’s travel insurer have to pay him $30,000 in damages?

“Can I claim for costs when I’m forced (by logistics) to continue my holiday?” 2017

Mary was injured on a day excursion during her cruise. Because of the cruise’s itinerary Mary was unable to return home until five days after the injury occurred. Is Mary able to claim ‘cancellation costs’ from the time of the injury because she couldn’t enjoy the cruise as she had envisioned?

“I just want my complaint resolved! I don’t care who resolves it” 2017

Holly switched motor vehicle insurers at her broker’s insistence. She made it clear that she wanted to continue ‘agreed pay out’ insurance with her new insurer. When Holly crashed her car, she found she only had ‘market value cover.’ Does Holly have recourse against the broker for this error?

Deep fat fryer fire 2017

What happens when a fish and chip shop deep fat fryer catches fire because it has not been properly serviced and maintained, in breach of the insured’s obligations to the insurer?

Tummy troubles 2017

Samantha’s kitten was unwell, but insurance policy excluded cover for gastro-intestinal disorders. Would the kitten be covered?

“Why can’t I claim insurance when I can’t use my business?” 2017

Sam’s business was severely affected by the Kaikoura earthquakes. Though his building was not materially damaged, a neighbouring building needed to be demolished before he could begin trading again. Was Sam able to use his business interruption insurance to cover his stop in trading in the intervening 8 months?

“It’s all mother nature’s fault, not mine!” 2017

Sally and her family were unable to get to Vanuatu for their planned holiday because of the impact that Cyclone Cook had on their flights. Sally and her family travelled by taxi from Wellington to Napier in order to try and make their international flight from Auckland. Twenty minutes from Napier, they learnt that the flight from Napier was also cancelled. The insurance company refused to pay for the taxis.

“How am I meant to know my conditions are related? I’m not a doctor.” 2017

Tim had a double bypass and aortic aneurysm a number of years ago, but had suffered no issues since. His medicine for these conditions hadn’t changed in a number of years. After declaring these conditions in his medical declaration, Tim obtained travel insurance with these conditions excluded from the policy. Days before he left on his trip to South Africa, Tim experienced major ‘cramp’ in his leg and could no longer travel. Did he have cover?

‘Have you heard the one about high value items?’ 2017

Thomas lost his hearing aids while holidaying in Hawaii. His claim for $9000 was accepted by his travel insurer, but a sub-limit for ‘electronic equipment’ meant he only received $2000 in settlement of his claim. The insurer said that if Thomas had wanted to insure his hearing aids for their full value, he should have specified them in the policy. Thomas said he didn’t know he had to specify hearing aids and he disputed that hearing aids were electronic equipment. Is the insurer right?