Tom’s insurer said if it had been told about the ear infection, it would’ve charged an extra premium.
Shortly before travelling, Tom had received prolonged treatment for an ear infection. The insurer considered this to be a significant change in health and if it had been told about this at the time, it would’ve charged Tom an extra premium.
Tom disagreed. He felt his condition wasn’t serious enough to inform his insurer and felt he was treated unfairly. So he contacted his insurer to complain.
Unhappy with the outcome, he approached our service for help and made a complaint.
What we said
We looked at all of the circumstances and Tom’s medical records showing what he’d been told about his ear infection by his doctor. We saw that Tom had been to the doctors three times over the course of a few weeks – first receiving ear drops and then antibiotics when the infection didn’t clear up. Although the doctor noted it was a severe infection, he told Tom it was likely to clear up with general antibiotics and that he was unlikely to experience any after-effects. There was no indication that Tom was given any reason to think it might be something more serious.
Overall, we didn’t think it was fair to consider the ear infection a significant change in health which Tom should’ve told his insurer about. So, we asked the insurer to pay the claim in full.
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