better banking

Claim for eye surgery costs declined

24 Nov 2016

Mr G applied for health insurance at his bank, disclosing that he had an eye disorder.  The policy underwriter offered insurance subject to a policy exclusion for the disorder and Mr G accepted the policy on those terms.

Several years later, Mr G required eye surgery but couldn’t claim on the policy due to the exclusion.  He said his bank should have advised him of other options when he first applied, including that he might be able to:

  • obtain cover for the eye disorder by paying a higher premium
  • have a time-specific exclusion for the eye disorder. 

He asked the bank to compensate him for the surgery cost, but it declined and he brought his complaint to our office.

We expect banks to recommend products and services which are suitable for a customer’s purposes.  We considered the policy put in place was suitable in Mr G’s circumstances. 

We advised Mr G that the bank was responsible for processing his insurance application but did not have a wider duty to provide advice about alternative insurance products.  Mr G accepted our view and withdrew his complaint.