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.

Excess dog damage

An excess is paid when claims are accepted. If there is more than one event, more than one excess can be applied.

Viv’s claim, for carpet damaged by dog vomit and diarrhoea, was accepted. But three policy excesses were applied.
House and Contents Insurance pets

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Son crashes car, no cover

Check your policy for exclusions. Insurers must act with reasonable care and skill.

Cora's car insurance claim was declined because her son was excluded as a driver. But Cora said he was covered.
Vehicle Insurance

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Skin surgery benefit changed

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

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

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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No ambulance cover for pre-existing conditions

Pre-existing conditions are excluded, unless your insurer has accepted them in writing and charged an extra premium.

Mae's daughter Eva collapsed at a restaurant in Australia. Mae later made a claim for the cost of an ambulance ride.
Travel Insurance

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No insurance for man who skipped flight to make cruise

If you choose to change travel plans, when you don't need to, this won't be covered.

Charles decided he couldn't run the risk of missing the cruise due to a cancelled flight. Instead, h...
Travel Insurance

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Fair Insurance Code Breach

Insurers bound by the Fair Insurance Code must provide agreed minimum standards of service to customers.

After Kim's claim, for cracking walls, was initially accepted, it was later declined.
House and Contents Insurance

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Coffee-stained carpet, dining room only

Check your policy limitations and exclusions.

After Viv's Nespresso coffee stained a patch of dining-room carpet, she wanted most of the carpet in the house replaced.
House and Contents Insurance

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Stolen car, no cover

Disclose past criminal convictions when you apply for insurance.

Tim's claim, for his stolen car, was declined because he hadn’t mentioned his criminal convictions. Tim said he wasn’t asked.
Vehicle Insurance

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The van, the can and the boom

Don’t tell tall tales – your claim will be checked.

Jean Paul claimed his van caught fire because a petrol can was knocked over during “sort of a romantic meeting”.
Vehicle Insurance False Statements

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A car bumped into me - no it didn’t

False statements can’t be retracted, and all policy holders are implicated.

Mr Green tried to withdraw a claim as he had told a “bit of a lie”. But it was too late.
Vehicle Insurance False Statements

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