Tina was on holiday in Japan when she cut her foot and received stitches. Tina had to visit two hospitals and get an X-Ray. She was unable to walk and had to commute everywhere by taxi.
The hospital surgeon verbally advised Tina to return to New Zealand as soon as possible to remove the drain in her foot in two days. Tina was told she would need to wait a number of hours for a medical certificate and pay a fee. Tina decided not to wait due to the state she was in. Tina returned to New Zealand five days earlier than planned.
Tina kept her insurer informed at all times after the accident. She was then surprised when her insurer declined to pay for her medical costs, taxi fares and cancelled air fare. The insurer agreed to pay for her medical expenses but said her policy required her to provide written medical advice asking her to return immediately to New Zealand. Tina said she was in a very bad state and couldn’t wait at the hospital for a number of hours. Tina complained to FSCL.
Review
The insurer decided to get a medical opinion in lieu of Tina’s medical certificate and reviewed Tina’s claim. They asked Tina to obtain a letter from her treating surgeon. On review, the insurer noted that Tina’s injury was quite severe and an early return to New Zealand would have been recommended.
Outcome
The insurer agreed to overturn its decision to decline Tina’s claim. It reimbursed Tina for her medical costs, and flight costs. However, it could only reimburse Tina $100 for the taxi fares, being the maximum amount available under her policy. Tina was not happy that she did not receive the full taxi fares, but decided to accept the settlement amount.
Insights
As the insurance policy forms the contractual basis between parties, it is the insured’s responsibility to read their policy and familiarise themselves with its terms. At claim time, an insurer will often require documentation to evidence the cancellation of travel for medical reasons. In this situation, Tina was lucky that the insurer acted fairly and reasonably by seeking further medical advice in lieu of a medical certificate, and paid out her claim.
