Insurer refused claim because of pre-existing condition

Insurance Medical Conditions

Bodhi took out a private health policy in late 2017. He contacted us because he’d made a claim for treatment of a lung condition in early 2018 that his insurer had declined. His insurer said his policy didn’t cover him for pre-existing medical conditions. 

How we helped

Bodhi said he had no idea he wasn’t covered, and no one had explained this to him until now. We checked the policy terms. These explained that pre-existing medical conditions weren’t covered. We also asked the insurer for the medical evidence it had relied on. The GP’s notes showed that Bodhi had been diagnosed with a lung condition shortly before he took out the policy. We checked how Bodhi had taken out the policy. The insurer explained he’d taken out the policy online and showed us a screenshot. The screenshot explained to Bodhi that any pre-existing medical conditions wouldn’t be covered by this policy.

Putting things right

We explained to Bodhi that we thought the insurer had given him enough information about the policy to decide if it was right for him. We said it was reasonable for the insurer to reject the claim because the terms excluded pre-existing medical conditions.