BNZ LIFE INSURANCE CLAIM DECLINED?

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PostPosted: Wed Jul 22, 2009 4:40 am   Post subject: BNZ LIFE INSURANCE CLAIM DECLINED?  

Hi my wife and i came across from the uk to live in New Zealand in feb 2008.



Prior to coming my wife had concerns in relation to lumps on her left breast. She had all this checked out and was told in 2007 that the lumps were nothing and all was normal



In september 2007 we had an immigration medical, again she was informed that all was ok and the lumps found were just grissel and age



In Feb 2009 my wife went to the doctors here in New Zealand as we are now reisidents here. She just had the lumps checked out again .They told her that she should get it looked at when she retuned from the uk after visiting her daugter.



Prior to her leaving we took out life insurance with BNZ and this cover started on 23/02/09



Critical conditions apply on this claim in relation to Cancer and entitlement of 25% life insurance is payable if the claim is accepted.



My wife returned and afterwards organised a visit to the doctors who arranged a more in depth examination.



The result on 23 march 09 confimed that she DID have breast cancer and subsequently has had her left breast removed.



We have submitted a claim to BNZ who are at this moment still being a pain and want further questions answered.



They are saying that because she went to the doctors prior to the cover starting, the discovery was found then and not after the cover had started



There has been NO CONFIRMATION OF CANCER by any doctors be it in UK or NZ untill after the cover was taken out.



Finally my question is this, Does the fact that my wife going for a normal check up in NZ about her lumps found, as she had done several time in the UK, prior to the cover, Give BNZ in this situation a clause to decline payment because of that sole reason



Personally i think this is a very grey area for them and they are trying to get out of paying.



At this moment the claim has not been declined but more letters being sent out and more questions asking for more details ,even though we are sure we have given them everthing we can



This situation is starting to get us down and we think that the claim is going to be decliined in the near future by BNZ

ianelford
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PostPosted: Wed Jul 22, 2009 9:31 am   Post subject:   

Hello Ianelford,



Quote:
They are saying that because she went to the doctors prior to the cover starting, the discovery was found then and not after the cover had started




Is it their only argument about declining the claim or there are other conditions too? When was the report generated that confirms her being a cancer patient? Was it before the policy date or after?



Have you had a chance to speak to your agent about it?
jeorge
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PostPosted: Wed Jul 22, 2009 10:17 am   Post subject: BNZ insurance claim  

Hi George



From what i have gathered this seems to be thier main reply in relation to the claim submitted



The cancer was diagnosed after the cover had started



When you mean agent whom r u refering to? The doctors or BNZ?


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ian elford
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PostPosted: Wed Jul 22, 2009 10:17 am   Post subject:   

Make sure that you get answers from people who are fluent in the life insurance laws of New Zealand. I don't think that we have any licensed New Zealand agents here.

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PostPosted: Wed Jul 22, 2009 1:16 pm   Post subject:   

Quote:
The result on 23 march 09 confimed that she DID have breast cancer and subsequently has had her left breast removed.




So you have the medical report supporting this...right?



If the document supports it to be 23rd Mar and if the policy papers show the date of commencement to be Feb '09, then there shouldn't be any problem.

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Purpleheaded08
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PostPosted: Thu Jul 23, 2009 3:57 am   Post subject:   

Hello Ian,



Thanks for your reply Smile



By the term 'agent' I meant the insurance agent who has sold you the policy. Sorry about the confusion. Embarassed



I think, I can now see their point. There is only a month's gap between the commencement of the coverage and the report confirming her medical condition. May be their argument is that one can't develop cancer within a month. She has had the issue prior to obtaining the policy, only it wasn't confirmed.



Anyway, I agree with Insurance Expert. You need to speak to someone who is familiar with the NZ life insurance laws because what we may suggest would apply to the US context but it might or might not fit to your situation.

jeorge
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PostPosted: Thu Oct 28, 2010 2:40 am   Post subject: BNZ claim  

Hi

I'm an insurance adviser in NewZealand. A couple of points:

1) BNZ Life cover is sold by the bank by its own officers, not by 'agents' as such. It is a bank product only available through BNZ but it is underwritten by (currently) Lumley Life.

2) Most trama covers have a 90 day stand-down period for a number of conditions, INCLUDING cancer. Without some seriously mitigating factors, this claim cannot succeed.

This is a classic case, from the underwriters' viewpoint. The applicant had checked the lumps several ties and tld they were benign. However, there's no mention of any biopsies at any of those events. Then, mysteriously, a new doctor, in NZ, recmmends they be checked again, but only on return from a trip. At what appears to be the same time (almost) an applicaton is made. Go figure, that this occurs when a doctor indicates further tests should be undertaken.

However, even this doesn't feel right: in my experience, if a doctor hs ANY suspicions about abreast lump, the biopsy would be done immedately - the next day at latest - NOT be left untl a trip overseas has been completed.

All in all, it does't smell good, and there are several contractual reasons why the insurer should not pay, and some evidence of potential moral haxaerd as well.

I'd be interested t know what the outcome was. If any payment was made, it would certinaly have been ex gratia.


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Majella
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