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Insurer’s decision overturned by Ombudsman…
The insured took out a policy for health insurance which included a public hospital cash grant. The insured’s son was hospitalised in the public hospital for 10 days with internal injuries after a bike accident. The insurer declined the claim for the public hospital cash grant on the basis that the policy had excluded “any claim for costs or related costs for acute admission to a public hospital”.
The Insurance Ombudsman found that this was not a claim for costs for acute admission to a public hospital as there were no costs incurred, but was a public hospital cash grant. The insurer agreed to pay the claim following the decision of the Insurance Ombudsman’s Office.
Insurance Lawyer
Wellington
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