Case Studies

The following case summaries highlight common issues and consumer tips. Cases can be filtered by subject below and names have been changed to protect confidentiality. Access to the full case study database is available for IFSO Scheme Participants in the Participant Area.

Skin surgery benefit changed

Check your policy to see if your insurer can change your policy cover.

Kaia’s health insurer wrote to inform her it was changing the limits for skin surgery under her policy.
Health Insurance

See the case summary

Bad knee, no cover

Health insurance won’t pay claims for pre-existing conditions, unless the insurer has agreed.

Kate needed a knee replacement but her insurer wouldn’t pay, as she'd had knee pain 16 years earlier.
Health Insurance

See the case summary

Leaving out medical details is a problem

Tell your insurer your full medical history, even if you don’t think it's relevant.

Yasmin didn’t mention her two spinal injuries when she applied for insurance. Her claim for a spinal cyst was declined.
Health Insurance Non-disclosure

See the case summary

No ambulance cover for pre-existing conditions

Pre-existing conditions are excluded, unless your insurer has accepted them in writing and charged an extra premium.

Mae's daughter Eva collapsed at a restaurant in Australia. Mae later made a claim for the cost of an ambulance ride.
Travel Insurance

See the case summary

No insurance for man who skipped flight to make cruise

If you choose to change travel plans, when you don't need to, this won't be covered.

Charles decided he couldn't run the risk of missing the cruise due to a cancelled flight. Instead, h...
Travel Insurance

See the case summary

Fair Insurance Code Breach

Insurers bound by the Fair Insurance Code must provide agreed minimum standards of service to customers.

After Kim's claim, for cracking walls, was initially accepted, it was later declined.
House and Contents Insurance

See the case summary

Coffee-stained carpet, dining room only

Check your policy limitations and exclusions.

After Viv's Nespresso coffee stained a patch of dining-room carpet, she wanted most of the carpet in the house replaced.
House and Contents Insurance

See the case summary

Stolen car, no cover

Disclose past criminal convictions when you apply for insurance.

Tim's claim, for his stolen car, was declined because he hadn’t mentioned his criminal convictions. Tim said he wasn’t asked.
Vehicle Insurance

See the case summary

The van, the can and the boom

Don’t tell tall tales – your claim will be checked.

Jean Paul claimed his van caught fire because a petrol can was knocked over during “sort of a romantic meeting”.
Vehicle Insurance False Statements

See the case summary

A car bumped into me - no it didn’t

False statements can’t be retracted, and all policy holders are implicated.

Mr Green tried to withdraw a claim as he had told a “bit of a lie”. But it was too late.
Vehicle Insurance False Statements

See the case summary

Teenage son flips parents’ car

It’s unlikely you’ll have cover if an accident occurs when you’re in breach of licence.

Simon, on a restricted licence, flipped his parents’ car while his sister was in the passenger seat.
Vehicle Insurance

See the case summary

No cover for learner driver with passengers

Don’t expect to be covered if an accident occurs when you’re in breach of licence.

When Karl, with a learner driver’s licence, crashed on the Rimutaka ranges, he had 3 passengers. His claim was declined.
Vehicle Insurance

See the case summary