Insurance Company Claims Acoustic Neuroma Is Not In The Brain

[mucha]

Paul,

Thank you for your post - good to hear some reassuring news. Yours is similar to Richard (sporeguy) from Singapore - somewhere on this forum - who didn't have any issues either when claiming against an identical policy definition to ours.

I would suspect yours is very similar to Richard's and ours. If its not asking too much, would you be able to post the description of the definition of 'benign brain tumour' in your policy? We really can't understand why our insurer is holding out with such a feeble defence.

I think sometimes insurers want to see how far they can push you before you give in. Unfortunately we seem to be copping that and the process takes an extraordinarily long time to resolve.

Fortunately for them insurers in Australia are exempt from the legal concept of 'bad faith' that other businesses are subject to. Even after the Act was revised last year, that portion was deferred for further review in the new parliament (after September 2013 elections).   

[opp2]

I have insurance for accidental death and dismemberment including coverage for the loss of hearing in one or both ears.
I was approved for a payout of about $3700 after I lost my hearing in my an ear. I was excited to hear I was approved but reminded the administrator of the insurance policy that the payout should be 1/3 of the total policy so I should have received $87000.

I was promptly denied and told that because I lost my hearing due to a surgery it was not an 'accident'.

Insurance companies suck.

[jockieau]

Just to give you an update, we had our mediation on Friday. They have ‘softened’ their position now but still maintain their stubbornness.

Having viewed our overwhelming medical expert evidence, they are now hesitant to argue on ‘medical grounds’ and are now pushing that the definition of brain in their policy is based on the ‘old English’ interpretation. Given that every other definition in their policy is quantified or referenced to American Medical Association (AMA) medical definitions, we find this argument hard to follow.

So they have increased their offer from less than 5% prior to mediation to 15% during mediation to 30% at the end. In their own words, they are increasing their offer because they consider it a risky case to be fighting. Unfortunately 30% breaks even for us and we end up with nothing.

For us what defies logic, is that they still maintain that they will not settle the full amount. So we will now proceed to trial – a calculated risk. Fingers crossed…

I have been on this forum for a few years now and in fact posted my very similar issue with my insurance company to "Mucha". Unfortunately I missed Mucha's post last year as I would be very interested in talking with him. I am also in Australia and my claim was denied for the same reason. I do know that in the UK they now have standard definitions and I would have been fine had I been there - but it seems that in Australia they can still get you with the fine fine print!

I have sent Mucha a PM but have not heard anything. Did anyone have any contact with Mucha or know how I might be in contact with him? If they went through exactly the same as me it would be invaluable to find out how they got on.

Any advice? Thanks!