Mia’s situation
Mia was a post-graduate university student in New Zealand and she held travel insurance covering her while she lived here. This included cover for medical expenses. Prior to studying in New Zealand, she had been studying in Australia. During her studies in Australia she fell ill and was admitted to hospital for 2 weeks with suspected appendicitis. Mia’s appendix was removed but it transpired that Mia was actually sick from an infection.
Mia falls ill
In October 2013 Mia took up her studies in New Zealand. Soon after starting her studies she began to feel generally unwell. She went to the university health centre in January 2014 and had blood tests. The tests revealed that Mia had latent tuberculosis (TB), meaning that at some stage Mia had been exposed to TB. Mia said the symptoms which caused her to go to the medical centre in the first place were not the symptoms of latent TB; TB was simply picked up in the blood tests.
Because of the risk to the general population with TB, the diagnosis was serious and Mia was referred to a specialist. Mia then contacted her travel insurer to seek cover for various tests, x-rays, and specialist appointments. Mia said she had trouble getting medical invoices paid by her insurer and there were long delays.
Mia gets sicker
Mia’s doctors prescribed her very strong antibiotics to try and eradicate the TB. Mia began to feel nauseous and could not concentrate. In May 2014 she was diagnosed with medically induced hepatitis – the strong antibiotics she was taking had affected her liver function.
Mia then returned home to her home country for a few months to be cared for by her mother while she recovered from the hepatitis. Mia’s insurer covered the costs of her returning to her home country, and travelling back to New Zealand.
Mia’s ongoing medical costs
After returning to New Zealand a few months later, Mia continued to require medical care. This included mental health treatment – her sickness had caused her a significant amount of stress especially as she had to defer her studies. The nature of Mia’s medical care was that she was seeing a number of medical specialists and had to submit medical bills regularly. Mia said that it would take a long time to get bills reimbursed which put her under financial strain, and she was always dealing with different people at the insurance company.
No more cover?
Then, in September 2014, Mia received a letter from her insurer saying she was no longer covered because her sickness resulted from a pre-existing medical condition (the pain and hospitalisation in Australia a few years before). Mia’s insurer said that up until that point, it had made an error by paying her claims because her circumstances meant she actually had no cover under the policy.
Mia felt that this letter came ‘out of the blue’ and she was unable to provide any medical evidence to show that she did not have a pre-existing medical condition, before her insurer made its decision. Mia said that the latent TB was not the result of any pre-existing medical condition and was not related in any way to the abdominal pain she suffered in Australia in 2013. Mia’s insurer later confirmed that it would continue to cover her for all medical expenses she incurred in New Zealand. However, Mia said it continued to be difficult to communicate with her insurer and have medical bills reimbursed in a timely and accurate manner.
Mia contacts FSCL
Mia spoke with us about her concerns about her insurance company in March 2015. Mia said that her claims for reimbursement were currently up to date, but she wanted her insurer to acknowledge that, in her view, it had mismanaged her claim. Mia said she wanted her insurer to know that its process caused her stress and put her under financial pressure. Mia felt that her insurer needed to be ‘held accountable’.
The benefits of conciliation
Our case manager contacted the insurance company noting that the relationship between Mia and the insurer had broken down. Because Mia and insurer were going to have an ongoing relationship, we suggested it would be a good idea to use the conciliation process to see whether that relationship could be repaired. We also reiterated to the insurer that having our CEO impose a decision on the parties may not actually resolve the complaint.
The conciliation conference is held
The insurer agreed that conciliation was the best way to move the complaint towards a resolution, and our case manager facilitated the conference with both parties over the telephone. Mia and the insurer’s complaints manager were able to reach a resolution to the complaint by way of a written agreement outlining the process by which Mia would submit her claims (including specific time frames). The complaints manager agreed they would personally manage Mia’s claims going forward.
For Mia in particular, the conciliation process allowed her to speak fully and frankly with the complaints manager about her concerns, and the complaints manager was able to alleviate these concerns. The resolution in this complaint was not about any type of compensation – it was not ‘about the money’. The ability for Mia to speak with her insurer directly about her concerns in a conciliation facilitated by our case manager, was part of the resolution of the complaint in and of itself.
