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Trouble with an eye – fit to fly?

The detached retina 

Phillip and Phyllis arrived into New Zealand from the Philippines on 18 December 2013 to visit their son Peter and his family. Phillip and Phyllis had return flights booked for 25 March 2014. 

On the trip to New Zealand Phillip noticed his vision was blurry. He visited an optometrist on 21 December 2013 and was referred to the hospital’s emergency eye clinic the same day. 

Phillip was diagnosed with retinal detachment of his right eye. The hospital doctors recommended that Phillip either return to the Philippines urgently for surgery or attend a private eye clinic for repair. When Peter spoke to the hospital staff he said he was told that the hospital could not provide the surgery that day because the surgeons were on their Christmas holidays. 

Phillip attended a private eye clinic on 23 December 2013. The private clinic doctor said that the delay that would occur if Philip flew back to the Philippines would affect recovery. However, the doctor also said that Phillip was fit to fly. 

Peter contacted his parents’ travel insurer to seek pre-approval to cover the cost of the surgery in New Zealand. The insurer declined to cover the cost of the surgery in New Zealand because all of the medical evidence concluded that Phillip was fit to fly. According to a section of the insurance policy, the insurer had the option to repatriate Phillip to the Philippines if he was ‘fit to travel’. 


Phillip and Phyllis remain in New Zealand 

The family contacted their family members and friends in the Philippines to enquire whether Phillip would be able to get the surgery urgently there. Indications were that there would be a delay because of the holiday period and a festival. 

In late January 2014, Phillip and Phyllis were still in New Zealand. The insurance company offered to cover the costs to repatriate Phillip and Phyllis to the Philippines. This cost was less than the amount of the surgery which may have cost around $5,000 if performed in a New Zealand public hospital, and more in a private hospital. 

The family did not accept the insurance company’s offer.  The insurer also cancelled the insurance policy on the basis that Phillip had not followed its direction to return to the Philippines, and had remained in New Zealand. 


FSCL’s review 

We agreed with the insurer that it was entitled to decline the claim. We agreed that the insurer was not required to consider the level of care/availability of surgeons in the Philippines when considering whether there was cover under the insurance policy. 

The policy wording was clear that the insurer only needed to consider whether Phillip was ‘fit to travel’, that is, ‘fit to fly’. If he was, the insurer could decide to repatriate him to the Philippines for surgery. 

The family said that the private eye clinic doctor told them the surgery was urgent. The family thought this meant that Phillip was not fit to fly. 

We found that all the medical evidence stated Phillip was fit to fly. We noted that although the private clinic doctor had said that the delay from travelling would delay treatment and recovery, Phillip  had been cleared to fly. 


The settlement 

We understood why the family did not decide to send Phillip home immediately, based on the fact that the private clinic doctor had said the surgery was urgent. In addition, the family had the right to complain and, coupled with the holiday period, there was an inevitable delay in the family making any final decision about returning to the Philippines. 

We suggested that the insurance company organise to send Phillip and Phyllis home immediately. The family decided not to return Phillip and Phyllis to the Philippines. They decided to stay until 25 March 2014 (their pre-booked flight date). 

We then negotiated a settlement under which the insurer agreed to: 

  • reinstate the policy for the rest of Phillip and Phyllis’ stay in New Zealand (until 25 March 2014), and 
  • reimburse Phillip’s costs of  attending the optometrist and the public and private hospitals (around $1,000).