In September 2016, Yasmin* arranged health insurance. In August 2017, Yasmin made a claim for the costs of an MRI and lumbar epidural cortisone injection, because she had a cyst on the left side of her spine. The insurer requested Yasmin's medical notes and found she hadn’t disclosed 2 previous spinal injuries from 2013 and 2016, a further episode of back pain, and a potential glaucoma diagnosis. The insurer said the non-disclosure was material and declined the claim.
Yasmin said her spinal injuries had been minor, as she had recovered after 2-3 weeks with rest and physiotherapy; the back pain was related to the left hip problem, which she had disclosed; and she wasn’t aware her optometrist had written to her doctor recalling her for further glaucoma testing.
However, the medical evidence was clear. Yasmin had been sent requests to undergo glaucoma tests. Information about the spinal injuries, and possible glaucoma, would have affected the insurer’s decision on the terms to offer Yasmin insurance. The insurer could impose retrospective exclusions for lumbar sacral spine and glaucoma and decline the claim.
Complaint not upheld.
*Names have been changed.