Man with Indian hospital bill argues “Australasia” must include “Asia”

Hospitalised with Covid in India, a man argued that because he was covered for 'Australasia' it meant he was covered for 'Asia', therefore his insurer should cover his claim. He brought his complaint to the IFSO Scheme.

Man with Indian hospital bill argues “Australasia” must include “Asia”

Man with Indian hospital bill argues “Australasia” must include “Asia”

J argued that the word “Australasia” included the word “Asia” and, therefore, his health insurer should pay his Indian hospital bills.

His complaint declined by the Insurance & Financial Services Ombudsman (IFSO) Scheme.

The man was travelling in India when he contracted Covid-19, incurring medical bills of $28,000.

Later, he was shocked when his health insurer informed him that his policy did not cover broad worldwide cover and was declining his claim. The insurer said that the term “Australasia” meant medical cover was only broadly applicable to treatment in Australia and New Zealand, not Asia. Additionally, the insurer said the policy excluded emergency treatment and J did not meet any of the requirements of the overseas treatment provisions.

J made a complaint about the insurer, saying he changed from his previous insurer, because his financial adviser told him that the new policy had worldwide cover. In addition, J believed that the wording was misleading as it said “Australasia”, which he believed meant Asia, including India.

Finally, J said that the brochure he was given prior to arranging the policy indicated the health cover applied worldwide.

The IFSO, Karen Stevens, found that the financial adviser was not the insurer’s agent and, therefore, the insurer was not responsible for any incorrect advice the adviser gave J.

Furthermore, when J arranged the insurance, the insurer was not told that the only reason he wanted to change was because of his understanding of the worldwide nature of the health insurance.

Ms Stevens found the brochure issued at the time reflected the actual policy wording and was not misleading. She also found that the “Australasian Coverage” itself made it clear that the benefit only extended to Australia and New Zealand. She found that the use of “Australasian” did not mean that the health cover was extended to Asia or, in particular, to India.

Consequently, the insurer did not misrepresent the cover to J and his complaint was not upheld by the IFSO Scheme.

“Never make assumptions about insurance policies. If you are unsure about the extent of cover, ask about it, and make sure you read the policy so you know what you’re insured for. If you leave it until you want to make a claim, it’s too late.”

Complaint No: 00220851

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