Ihaka first obtained health insurance in 2014 through his insurance adviser. The health insurance provided free cover for any children under two who were born to the policy holder during the duration of the policy. Before the child turned two, only a birth certificate was required to obtain cover. An additional application form would be required if they were added after their second birthday.
Ihaka and his partner Anahera had their first child in February 2015. Two months later they provided the adviser with their daughter’s birth certificate, and she was added onto the policy.
Ihaka phoned his adviser in June 2017 to let her know that they had welcomed another daughter in May, and that they wanted to add her to the health insurance. The adviser noted in her diary that she would require the child’s birth certificate, but Ihaka and Anahera said that they adviser did not tell them about this. At the same time, Ihaka and Anahera were focussed on a mortgage restructure, which the adviser was also assisting them with, so their communication was primarily about this. Later in June and July the adviser made two short file notes saying she chased Ihaka up about providing the birth certificate.
In May 2019, approximately three weeks before the younger daughter’s second birthday, the adviser emailed Ihaka a questionnaire to confirm that his insurance cover was still suitable. She noted that only the elder daughter was included on his health insurance, and a birth certificate and a completed application form was required to add their younger daughter onto the policy. A few days after her second birthday, Ihaka sent the adviser his younger daughter’s birth certificate. The insurer advised Ihaka that he would need to complete an application form, due to his daughter now being over two years of age.
Unfortunately, the younger daughter developed a health issue in November 2019. Ihaka asked the adviser what health insurance was in place for her. The adviser told him that no cover was in place because the application form had not been completed.
Ihaka and Anahera said that the adviser had been negligent by not ensuring health cover was in place for their daughter, and they complained to FSCL.
Ihaka and Anahera said that they had asked for their second daughter to be added to their policy shortly after she was born, and that the ongoing correspondence showed “regular contact about her assumed insurance”. They said they only discovered she did not have cover after she developed her health condition. Ihaka and Anahera believed the adviser was negligent for not ensuring their daughter had cover in place, particularly as they were concerned their daughter would now be uninsurable. Ihaka and Anahera said they were hurt and upset, and that their daughter not having cover unnecessarily added to their stress in a particularly difficult year.
The adviser said that she acted with reasonable care and skill to inform Ihaka and Anahera of their options, and that she explained the necessary steps Ihaka needed to take for cover to be placed. The adviser said that there was unfortunately no cover in place due to the birth certificate not being provided in June 2017 and the application form not being completed in May 2019.
We found that Ihaka and Anahera’s mistaken impression that their younger daughter was already insured did not appear to be the adviser’s fault. At no point did the adviser tell Ihaka that his daughter was insured – in fact, the evidence showed the adviser had told Ihaka more than once that his daughter was not covered.
Ihaka said that he was not told he would need to provide the birth certificate, but there was evidence to the contrary. The adviser’s diary notes showed she had followed up with Ihaka for the birth certificate on at least two occasions. These were not full diary notes, but they were adequate to show it was more likely than not that the adviser had asked Ihaka for the birth certificate on several occasions. Also, Ihaka had provided the birth certificate for his elder daughter, so had been through the process before.
Ihaka received annual notices from his health insurer that referred only to himself and his elder daughter. Ihaka could have seen that his younger daughter was not covered by the policy. It appeared that Ihaka had not read the letters.
We said Ihaka knew or ought to have known that he would need to complete an application form for his daughter after her second birthday. The month before the younger daughter’s second birthday, the adviser emailed Ihaka asking him to complete the application form. The adviser’s diary notes supported that she explained to Ihaka the need to complete an application form after he returned the birth certificate. We said Ihaka could not have reasonably thought that the birth certificate alone was sufficient to obtain cover.
The adviser’s primary role was to advise Ihaka, but it was up to Ihaka as to whether he took her advice. The adviser could not make Ihaka provide information or complete forms. The adviser had fulfilled her duties and obligations by providing Ihaka and Anahera with the forms and information that they required in order to obtain cover for their daughter.
We found that Ihaka and Anahera should discontinue their complaint.
Ihaka and Anahera disagreed with our preliminary decision, but they did not provide any new evidence to change our view and we closed our complaint file.
Insights for consumers and participants
Consumers seeking insurance advice should take care to complete all forms and provide all evidence requested from the adviser in a timely manner. They should also read the annual notices sent by the insurer to ensure that their cover is up to date.
Advisers should take clear and accurate notes of all interactions with consumers. The advice in this case was provided before the licensing regime for advisers came into force which requires advisers to keep good records. If this case had been about advice provided after the licensing regime came into force, we may have found that the adviser’s brief records were not adequate.