Kiwi woman compensated after insurer wrongly turns down insurance claim

Allianz Partners turned down the cancellation claim, saying that a bout of pneumonia the woman had in August 2018 was a “sign” or “symptom” of the condition, making it a pre-existing condition.

The Disputes Tribunal ruled in favour of the claimant, saying that the insurer used a definition of pre-existing condition that was not part of its policy.

“As the phrase ‘signs or symptoms’ does not form part of the relevant definition of a pre-existing medical condition, I do not need to consider further whether a bout of pneumonia is 2018 was a sign or symptom of antisynthetase syndrome,” Disputes Tribunal adjudicator Phena Byrne said in the ruling.

Byrne also said that Allianz Partners acted without the “reasonable care and skill” that policyholders should expect from their insurer.

While the Disputes Tribunal issues anonymous decisions and redacted the woman’s and the insurer’s names, the woman’s family has complained to regulators about Allianz. The family believes the insurer might have wrongly declined other people’s claims.

The same matter was brought to the Financial Services Complaints Limited (FSCL), which came out with its decision in April 2021. In that decision, FSCL chief executive Susan Taylor said Allianz Partners should pay the woman $2,000 compensation for the stress and inconvenience caused by its poor handling of the claim.

According to the report, the FSCL previously told Allianz Partners that it was “on notice” and that any more similar complaints could alert the Financial Markets Authority that there was a “systemic” failure at the insurer.

“Allianz Partners acknowledges it could have done better when handling this claim,” a spokesman for the insurer said in response to the Disputes Tribunal’s ruling. “Allianz Partners carefully reviewed and reflected on the Disputes Tribunal’s decision. It has undertaken careful checks to ensure this case was an isolated incident that was confined to its particular facts.”