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Insurance benefit falls on deaf ears

Todd attends a very loud concert

In February 2012 Todd attended the Doobie Brothers & Little River Band concert. After the concert Todd noticed a ringing in his left ear.

By January 2013 the ringing in Todd’s left ear had not improved and Todd visited an Otorhinolaryngologist (head and neck) surgeon. The surgeon confirmed that Todd’s hearing loss was most likely noise induced.

Todd had an accident insurance policy with Interact Insurance (“Interact”). Todd made an insurance claim to Interact for loss of hearing in his left ear.


The claim

To qualify for cover under Interact’s accident policy Todd must have suffered total, permanent and irreversible hearing loss in one ear.

When assessing Todd’s claim, Interact wrote to his surgeon to receive more information about Todd’s hearing loss. The surgeon responded: “Whether this loss of hearing in the left is total, permanent and irreversible? Certainly the hearing loss is not total but is likely to be irreversible and permanent.” 

Interact was satisfied, on the basis of the surgeon’s response, that Todd’s hearing was not total. Interact declined Todd’s claim because his loss of hearing did not meet the terms of the policy.


Todd’s view

Todd believed that his claim should be covered because his hearing loss did fall within the policy. Todd argued that although his hearing test showed that he could hear some sound and he was not profoundly deaf, the ringing in his left ear meant that he could not decipher any meaningful sound.


FSCL’s view

In our view, Todd’s hearing loss did not meet the terms of the policy and Interact was entitled to decline his claim. The policy wording was clear. To qualify for cover Todd must have suffered total, permanent and irreversible hearing loss in one ear. Interact was entitled to accept the surgeon’s expert medical opinion and to conclude that Todd’s loss of hearing was not total.

We recommended that Todd’s claim was not upheld and Todd withdrew his complaint.