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.

Excluding tonsils, not adenoids

Provide medical details for everyone under the policy.

Dougal's insurer declined to pay for his daughter Sally’s adenotonsillectomy, because she'd had enlarged tonsils.
Health Insurance

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Weight loss surgery excluded

Check your policy for exclusions.

Penny’s insurer declined to pay for weight loss surgery (a sleeve gastrectomy), recommended by her doctor.
Health Insurance

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Tooth extraction excluded from cover

Check your policy for exclusions.

Fiona's claim, for the surgical removal of her son’s tooth, was declined. The policy only covered wisdom tooth extraction.
Health Insurance

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Roger’s trip ends in tragedy, waiver applies

Pre-existing condition exclusions also apply to family members who aren’t travelling. Sometimes a waiver can apply, if there is proof the condition is stable

Just before he left on holiday, Vinnie's father died. Vinnie postponed his trip and made a claim.
Travel Insurance

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Mr M’s trip to NZ ends in tragedy

Pre-existing condition exclusions apply even if indirectly related.

Mr M’s heart attack was indirectly related to his hypertension and diabetes. His son’s claim for the...
Travel Insurance

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No cover for anxiety, loss of enjoyment

If a pre-existing condition is the cause of cancellation, the exclusion applies to all policy holders.

Louise’s daughter's anxiety prevented her from leaving the hotel, or participating in any activities, during their holiday.
Travel Insurance

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Storm in a tea shop, the unattainable police report

A police report is required to prove your loss. Some policies contain an exception when this not reasonably practicable.

When making a claim for his backpack, Ari had no police report. He had, however, tried to get one.
Travel Insurance

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Pania lost her ring in the sea, fake photos didn’t help

Report stolen or lost items to police immediately. To make a claim, you need to prove your loss and always tell the truth

Pania’s claim for her ring and iPhone was declined. She had no proof of loss.
Travel Insurance

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The great train station robbery

Check your policy exclusions. Don’t ever leave your bags unattended in public places

Raj's bag, worth $13,000, was stolen at Zurich train station when he walked briefly to the rubbish bin.
Travel Insurance

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The missing bag and the rotting meat

Check your policy exclusions. Don’t pack perishables in your checked luggage

When Amelia arrived in the States, her bag didn't. She returned to NZ to discover the bag was ruined, from rotting meat.
Travel Insurance

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Swiss watch swiped: Spain

Check for exclusions and limitations. Travel exceeded 90-day limit on credit card

The credit card travel insurance policy had a 90-day limit. The watch was stolen on day 57 of the 100-day trip.
Travel Insurance

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Mountain eruption not unexpected

Insurance covers unexpected events. Purchase insurance when you arrange travel.

Brendan purchased travel insurance after the eruption in Bali had been widely reported. His claim was declined.
Travel Insurance Travel

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