Case Studies

The following case summaries highlight common issues and consumer tips. Cases can be filtered by subject below and names have been changed to protect confidentiality. Access to the full case study database is available for IFSO Scheme Participants in the Participant Area.

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Man with Indian hospital bill argues “Australasia” must include “Asia” image
Man with Indian hospital bill argues “Australasia” must include “Asia”
A man complained to the IFSO Scheme when his claim for medical expenses in India were declined. He s...
Health Insurance Travel Travel Insurance medical Covid
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Skin surgery benefit changed image
Check your policy to see if your insurer can change your policy cover.
Kaia’s health insurer wrote to inform her it was changing the limits for skin surgery under her policy.
Health Insurance
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Bad knee, no cover image
Health insurance won’t pay claims for pre-existing conditions, unless the insurer has agreed.
Kate needed a knee replacement but her insurer wouldn’t pay, as she'd had knee pain 16 years earlier.
Health Insurance
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Leaving out medical details is a problem image
Tell your insurer your full medical history, even if you don’t think it's relevant.
Yasmin didn’t mention her two spinal injuries when she applied for insurance. Her claim for a spinal cyst was declined.
Health Insurance Non-disclosure
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Overseas treatment – no specialist letter, no cover image
If you’re making a claim for overseas treatment, contact your insurer well in advance.
The day before Ms B took her daughter to Australia for thyroid treatment, she phoned her health insurer to check the cover.
Health Insurance
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Excluding tonsils, not adenoids image
Provide medical details for everyone under the policy.
Dougal's insurer declined to pay for his daughter Sally’s adenotonsillectomy, because she'd had enlarged tonsils.
Health Insurance
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Weight loss surgery excluded image
Check your policy for exclusions.
Penny’s insurer declined to pay for weight loss surgery (a sleeve gastrectomy), recommended by her doctor.
Health Insurance
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Tooth extraction excluded from cover image
Check your policy for exclusions.
Fiona's claim, for the surgical removal of her son’s tooth, was declined. The policy only covered wisdom tooth extraction.
Health Insurance
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