On a trip to New Zealand to visit his son Richard*, Mr M was admitted to hospital with a heart attack, and later died. He had insurance cover for his trip.
Richard made a claim for the cost of hospitalisation, which was declined because the insurer believed Mr M’s heart attack was indirectly related to his hypertension and diabetes, which he was diagnosed with many years prior. The insurer needed to prove that the costs resulted either directly or indirectly from an existing condition. While Mr M was not aware of his heart condition, the medical evidence suggested Mr M’s diabetes contributed to his death. The insurer, therefore, had proof the medical costs were related.
Therefore, the insurer was entitled to decline the claim.
Complaint not upheld.
*Names have been changed.