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Insurers and banks are rejecting claims for Christmas accidents
Christmas can bring many unforeseen challenges. Someone buys light cream that is not right for the pavlova. You lose your last table tennis ball. Someone misunderstands Secret Santa and one person gets two presents and the other gets none. (This has only happened once in my family.)
But have you thought about how your insurance might surprise you?
A search of the Financial Services case study archive shows that the ombudsman has faced a number of festive issues over the years.
In one case, a man traveled to Boston for Christmas with his friends.
He had a few drinks in a bar, lost consciousness and woke up in the hospital.
But his insurer denied his claim for treatment – which cost $3,192 (about NZD 5,700) – because it had an exclusion for health events caused by alcohol.
The Kiwi said he had only had three beers, so something must have been added to his drink.
FSCL said the doctors who treated him would have been experienced in dealing with these situations and would have done further tests if they were unsure of the cause of his illness.
'We noticed that too [he] was presented at the hospital at 2:06 a.m., which could indicate that he had been at the bar for quite some time. Furthermore, the medical notes did not support his claim that he was simply eating and having a few drinks at the bar when he collapsed.
“After weighing the medical evidence, we agreed that the insurer was entitled to rely on the alcohol exclusion to deny his claim.”
In another case, a man received a text message saying he could get a holiday payment holiday on his loan.
He called to ask about the terms and was told he would be given four weeks without payments and would not be charged.
To compensate, the term of the loan would be extended.
He agreed to the vacation, but realized a few months later that the four-week break had added another eight weeks to his loan period.
“[He] said he understood the lender's explanation that he would not be liable for late fees, which meant he would not have to pay any interest over the four weeks.
“[He] felt it was unfair of the lender to extend his loan by eight weeks when he only got four weeks' holiday.”
The lender said that although no late fees were charged over the holiday period, interest continued to accrue, resulting in an extension of the loan term by four weeks.
FSCL investigated and said the agreement clearly stated that interest would be charged and the loan tenure would be extended.
In another case, a woman reportedly flew from Nashville to New Zealand over Christmas – via Dallas and Houston.
But her flight from Dallas to Houston was canceled and she couldn't get a new one until 48 hours later, causing her to miss her connection to New Zealand.
She had to take medication daily and only had enough for 24 hours.
She rebooked via Los Angeles and Brisbane, but her flight to Los Angeles was also delayed – and she missed her connection to Brisbane.
She instead booked to New Zealand via Honolulu and arrived home 24 hours later than originally expected.
She claimed on her travel insurance for $3,882 in flights, $105.41 in flight and airport taxes and $14.09 in food at the Dallas airport.
The insurer only paid the $14.09. It said it only paid airfare for the outward leg of a trip.
She did not accept that decision and said she would have claimed more for food and lodging expenses if she had stayed in Dallas for 48 hours.
The insurer offered to pay her $185.91 in full and final settlement, which reflected the maximum amount of $200 it offered on the policy for food and lodging expenses.
FSCL said the woman should have had more than 24 hours' worth of medicine with her as flights could be delayed, especially around Christmas.
'We didn't agree with it [her] believes that there could be coverage for costs incurred due to return journey delays. The policy clearly stated that these costs were only covered on the outward journey. This meant even if [she] If you had stayed in Dallas for 48 hours and still incurred rebooking fees, these costs would not be covered.
“We also noticed that when there is a flight delay or cancellation, most airlines simply book customers for free on the next available flights to reach their destination. This was why the insurance policy only provided $200 for accommodation and food costs while a person waits for their rescheduled flights.”
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Sources 2/ https://www.rnz.co.nz/news/business/537253/insurers-banks-decline-claims-for-christmas-mishaps The mention sources can contact us to remove/changing this article |
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