SERVICE: Motor Vehicle
OUTCOME: Not upheld
Issues: Policy Exclusion
Mr R held insurance on his motor vehicle.
In March 2019, Mr R was driving his motor vehicle on a walkway and forced the vehicle between two large palm trees. The police attended, Mr R was taken to hospital, and the police advised that Mr R refused to give a blood sample.
Mr R made a claim to the insurer for the damage. The insurer relied on a policy testing exclusion to decline the claim, which applied where Mr R refused to give a blood sample.
Mr R said he had been threatened and followed in the lead up to the accident. Following the collision, Mr R was further in distress as he had unfortunate memories of paramedics and hospitals. Mr R was more focused on getting away from the vehicle and out of the hospital as quickly as possible. Mr R offered to provide a breath test or not-so-invasive sample; this was declined by Police. Mr R did not provide consent to a blood sample and did not understand why one was required.
The case manager’s assessment
When the insured makes a claim under an insurance policy, the law says that it is up to them to prove that they have suffered a loss, which is covered by the policy.[1]
The insurer can then choose whether to apply a policy condition or exclusion to limit or decline a claim. If the insurer does choose to do so, it must prove the condition or exclusion applies.
The insurer declined the claim on the basis that Mr R failed or refused to permit a specimen of blood to be taken after having been lawfully required to do so. Therefore, the exclusion for testing applied.
Mr R confirmed that he refused to permit a specimen of blood to be taken, saying that this was because of his past traumas in hospitals, misdiagnosis of close relatives and because Mr R did not see why a blood sample was needed.
The police also confirmed Mr R received a conviction, because he failed or refused to permit a specimen of blood to be taken after having been lawfully required to do so.
Regardless of Mr R’s personal reasons for declining to provide a specimen of blood, as he refused, the insurer could rely on the testing exclusion to decline the claim.
Complaint No: 00230632
[1] This is known as a prima facie claim.