GROUP: Insurance - Fire & General
SERVICE: Travel
OUTCOME: Not upheld
Issues: Policy Exclusion
Summary: Mr H’s complaint was not upheld, because he did not incur any dental expenses during the period of cover and, in any case, dental expenses incurred in New Zealand were excluded by the policy.
Mr H held travel insurance for his international trip in May 2024.
During the trip, Mr H cracked his tooth, while trying to open a bottle.
When he returned to New Zealand, Mr H went to a dentist, who said he needed a crown.
Mr H made a claim to the insurer, for the cost of the crown.
The insurer declined the claim, because it said that Mr H was not claiming for dental expenses incurred during the period of cover, and the claim was excluded because dental expenses incurred in New Zealand were excluded by the policy.
The case manager’s assessment
Because Mr H did not incur any dental expenses during the period of cover, and his cover under the policy ended when he returned to New Zealand, he did not have a prima facie claim, under the policy.
Furthermore, the policy had an exclusion for dental expenses incurred in New Zealand. Because Mr H wanted the insurer to pay for dental expenses which were going to be incurred in New Zealand, those expenses were excluded by the policy.
Complaint No: 00233461