Successful Claim on a Lapsed Policy

Claimant: 46-year-old male
Condition: Crescendo angina
Insurance Claim: Trauma insurance

When Mr A suffered from crescendo angina that required the insertion of two stents for his blocked arteries, he had no idea he wasn’t covered by insurance. Mr A rang us from the hospital after the surgery to ask if he would get paid on his Trauma cover. However, when we investigated his policy, we discovered it had lapsed around 8 months ago due to non-payment of premiums. Mr A had tried to reinstate the policy but could not provide the required information, and as a result, the provider closed the case 2 months later — six months before the episode.

We investigated the communication that had occurred between the provider and Mr A to get an understanding of how it led to the cancellation of the policy. We successfully found enough grounds to argue for the policy to be reinstated, backdated to 6 months prior to the medical condition. The provider rejected the request, so we escalated it to the Internal Dispute Resolution — they also upheld the original decision. We went to FOS and were finally successful. After the policy was reinstated, we lodged a successful Trauma claim — as if the cover was in place all along.

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