There can be a lot of unforeseen challenges at Christmas.
Someone buys lite cream that won’t whip for the pavlova. You lose your last table tennis ball. Someone gets the Secret Santa wrong and one person gets two presents and another gets none (this has happened only once in my family).
But have you thought about how your insurance might surprise you?
A search through the Financial Services Complaints case study archive shows the Ombudsman scheme had dealt with a number of festive predicaments over the years.
In one case, a man travelled to Boston for Christmas with his friends.
He had a couple of drinks at a bar, lost consciousness and woke in hospital.
But his insurer declined his claim for treatment – which cost $3192 USD (about $5700 NZD) – because it had an exclusion for health events caused by alcohol.
The Kiwi said he had only had three beers so his drink must have been spiked.
FSCL said the doctors who treated him would have been experienced in dealing with these situations and would have done further tests if they were unsure about the cause of his illness.
“We also noted that [he] presented at the hospital at 2.06am, which would suggest he had been at the bar for quite some time.
“In addition, the medical notes did not support his submission that he was simply having dinner and a few drinks at the bar when he collapsed.
“Weighing the medical evidence, we agreed that the insurer was entitled to rely on the alcohol exclusion to decline his claim.”
In another case, a man received a text message telling him he could have a payment holiday on his loan over the festive season. He called to ask about the terms and was told it would give him four weeks with no payments and no fees would be charged.
The loan term would be extended to make up for it.
He agreed to the holiday but a few months later realised that the four-week break had added another eight weeks to his loan term.
“[He] said that he understood the lender’s explanation, that he would not be liable for arrear fees, to mean that he would also not have to pay any interest over the four weeks.
“[He] felt that it was unfair of the lender to extend his loan by eight weeks when he only received a four-week holiday period.”
The lender said that, although it did not charge arrear fees over the holiday period, interest kept accumulating, which resulted in the four-week extension to the loan term
FSCL investigated and said the agreement clearly stated interest would be charged and the loan term extended.
In another, a woman was due to fly from Nashville to New Zealand – via Dallas and Houston – over Christmas. But her Dallas to Houston flight was cancelled and she could not get another one until 48 hours later, so she missed her connection to New Zealand.
She had to take medication daily and only had enough to cover her for 24 hours.
She rebooked via Los Angeles and Brisbane, but her flight to Los Angeles was also delayed – and she missed her connection to Brisbane.
She booked through Honolulu to New Zealand instead and arrived home 24 hours later than originally expected.
She claimed on her travel insurance for $3882 in flights, $105.41 in flight and airport taxes and $14.09 for food at Dallas airport.
The insurer only paid the $14.09.
It said it only paid flight costs on the outward leg of a trip.
She did not accept that decision and said she would have claimed more for food and accommodation costs if she had stayed in Dallas for 48 hours.
The insurer offered to pay her $185.91 in full and final settlement, which reflected the maximum $200 it offered for food and accommodation costs on the policy.
FSCL said the woman should have carried more than 24 hours’ worth of medicine given that flights could be delayed, particularly around Christmas.
“We did not agree with [her] view that there could be cover for costs incurred as a result of delays, on a return leg of a journey. The policy clearly stated there was only cover for these costs on the outward leg of the journey. This meant even if [she] had stayed in Dallas for 48 hours, and still incurred rebooking costs, those costs would not be covered.
“We also noted when there is a delay or cancellation of flights, most airlines simply book customers on the next flights available to get to their destination, free of charge.
“This was why the insurance policy only provided $200 for accommodation and food costs, while a person awaits their rescheduled flights.”
rnz.co.nz
