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8719 posts

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  # 2089459 12-Sep-2018 18:27
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tdgeek:

 

The Ombudsman and the Government and Opposition need to legislate that these terms are simpler to understand.

 

 

FWIW, the Ombudsman and the Insurance Ombudsman are completely different.

 

I'm surprised at the level of confidence some people seem to have in insurers "doing the right thing" morally.

 

When there's a dispute, it's not easy to sort. 

 

The OIO seems like a great thing - I have my doubts.  Before the Insurance Ombudsman can get involved to resolve a dispute "deadlock" must be formally declared.  The customer doesn't get to declare when "deadlock" is reached - only the insurance company does.  Your alternative is to sue the insurer through the court system.
If I was the insurer, I'd probably only want to declare "deadlock" promptly in cases with high expectation that the OIO was going to rule against the client in a dispute.  The ones where the customer might win, the insurer may be inclined to delay, distract, and defer for as long as possible.  Let the client try to sue through the courts. They'll run out of cash long before the insurer does.

 

A couple of young litigation lawyers I know have worked consecutively for the same large firm in recent years.  One found the experience so unpleasant he was determined to give up law entirely and resigned.  By coincidence I know his replacement at that firm quite well.  They tell the same story.  The "insurance jobs" come into the office and get allocated - nobody wants them.  If you're young and (still) keen they end up on your desk.  It's soul destroying.  You're given a client (with limited financial resources) to fight a case. You're probably going to lose - because the insurance company will throw 10x the resources into the case than you've got available.  The clients have stewed over the situation for years of delays and have also dug in - reluctant to take a settlement for less than they believe is due. 

 

I wouldn't expect government to intervene with a heavy hand.  If they do, then if the insurers consider it too onerous. they'll walk away from the NZ market - which would be extremely damaging to the economy.

 

Pays to remember that the insurance industry was originally founded on the basis of shared risk, the "mutual" model which since the demise of AMI in NZ is now gone.  Once, the primary objective was to share risk between policyholders, now the primary objective is to return as much profit as possible to shareholders.

 

 


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  # 2089509 12-Sep-2018 19:09
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Rikkitic:

 

To return to the question, yes, I think people like this should be helped. There have been some unkind suggestions made about this lady's motives and the usual bleatings about setting precedents, but a situation like this will always be exceptional and I think exceptional circumstances warrant exceptional measures. The poor woman is dead. She was made to die in a foreign hospital in a foreign land. A more compassionate response would have been at least a greater willingness to bring her home, regardless of the cost or who had to pay for it. When people are in trouble, you help them. You don't ask if it was their own fault or whether they took adequate precautionary measures. We spend fortunes every year lifting people off mountains or plucking them from the sea. Maybe some of the cost is recovered, but no-one asks in advance if they can pay, or refuses to help because they brought it on themselves. 

 

If you were tramping in the hills and you came upon someone having a heart attack, would you just ignore them and carry on? What matters for me in this case isn't the specifics of this woman's medical condition, or whether is was possible to return her to NZ, or whether enough money was raised to cover the costs, or whether she was trying to pull a fast one on the insurer. What matters is the apparent reluctance of many people to help someone in need, and the reaching for justifications that it was somehow her fault anyway. I would have hoped for a little more generosity of spirit here.

 

 

 

  

 

 

You can't say that. This is not exceptional. Its also not an insurance issue as she had none tat covered her. No one here that I recall has "unkind suggestions made about this lady's motives and the usual bleatings about setting precedents" As per my post, there are, at any time, 3000+ issues, and 200+ emergencies. This one, sad as it is, is not an exception. 

 

If you see that the Govt should support all of these every year, thats ok. But don't make this a one off, as it isnt. Notably, this has never been an insurance issue. The family chose unwisely to not insure her pre existing condition. 


 
 
 
 


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  # 2089510 12-Sep-2018 19:12
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Rikkitic:

 

Well then, I guess the world sure got even with them! Undeserving obfuscatory muttering types that they are. 

 

 

 

 

No, they aren't. And you know that. We either have an insurance system or we get the Govt to do it. Both will charge. The family did not buy insurance, and thus, they have not complained they didn't get paid out. 


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  # 2089513 12-Sep-2018 19:16
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Fred99:

 

tdgeek:

 

The Ombudsman and the Government and Opposition need to legislate that these terms are simpler to understand.

 

 

FWIW, the Ombudsman and the Insurance Ombudsman are completely different.

 

I'm surprised at the level of confidence some people seem to have in insurers "doing the right thing" morally.

 

When there's a dispute, it's not easy to sort. 

 

The OIO seems like a great thing - I have my doubts.  Before the Insurance Ombudsman can get involved to resolve a dispute "deadlock" must be formally declared.  The customer doesn't get to declare when "deadlock" is reached - only the insurance company does.  Your alternative is to sue the insurer through the court system.
If I was the insurer, I'd probably only want to declare "deadlock" promptly in cases with high expectation that the OIO was going to rule against the client in a dispute.  The ones where the customer might win, the insurer may be inclined to delay, distract, and defer for as long as possible.  Let the client try to sue through the courts. They'll run out of cash long before the insurer does.

 

A couple of young litigation lawyers I know have worked consecutively for the same large firm in recent years.  One found the experience so unpleasant he was determined to give up law entirely and resigned.  By coincidence I know his replacement at that firm quite well.  They tell the same story.  The "insurance jobs" come into the office and get allocated - nobody wants them.  If you're young and (still) keen they end up on your desk.  It's soul destroying.  You're given a client (with limited financial resources) to fight a case. You're probably going to lose - because the insurance company will throw 10x the resources into the case than you've got available.  The clients have stewed over the situation for years of delays and have also dug in - reluctant to take a settlement for less than they believe is due. 

 

I wouldn't expect government to intervene with a heavy hand.  If they do, then if the insurers consider it too onerous. they'll walk away from the NZ market - which would be extremely damaging to the economy.

 

Pays to remember that the insurance industry was originally founded on the basis of shared risk, the "mutual" model which since the demise of AMI in NZ is now gone.  Once, the primary objective was to share risk between policyholders, now the primary objective is to return as much profit as possible to shareholders.

 

 

 

 

There is no deadlock with this one. The family did not insure, so there is no case. I never implied suing. I said the terms should be clearer, thats all. That helps non legal people, as already implied by our resident lawyer. This family did not insure, as evidenced by no issues with the insurer, and the Govt stating they should have got the correct cover.


8719 posts

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  # 2089514 12-Sep-2018 19:22
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tdgeek:

 

Rikkitic:

 

Well then, I guess the world sure got even with them! Undeserving obfuscatory muttering types that they are. 

 

 

 

 

No, they aren't. And you know that. We either have an insurance system or we get the Govt to do it. Both will charge. The family did not buy insurance, and thus, they have not complained they didn't get paid out. 

 

 

I thought they did buy insurance, but the claim was denied because they didn't disclose a preexisting condition.  The "moral argument" (not that it matters as a contract is a contract - and the insurance company must deliver a profit) is perhaps whether they didn't know - or they did know and tried to deceive or "take a gamble".

 

So far there's been no answer to that question.


567 posts

Ultimate Geek


  # 2089515 12-Sep-2018 19:23
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This has been a hot topic at work this week. My colleage's husband was quoted an additional $600 to cover a preexisting heart condition for a trip to the states recently. My wife's grandmother is in the states at the moment and paid around $1k to cover a range of preexisting conditions.

Unfortunately this family decided the extra cost was not worth it.

Hopefully this case will prevent other people making similar decisions.

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  # 2089522 12-Sep-2018 19:28
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Fred99:

 

tdgeek:

 

Rikkitic:

 

Well then, I guess the world sure got even with them! Undeserving obfuscatory muttering types that they are. 

 

 

 

 

No, they aren't. And you know that. We either have an insurance system or we get the Govt to do it. Both will charge. The family did not buy insurance, and thus, they have not complained they didn't get paid out. 

 

 

I thought they did buy insurance, but the claim was denied because they didn't disclose a preexisting condition.  The "moral argument" (not that it matters as a contract is a contract - and the insurance company must deliver a profit) is perhaps whether they didn't know - or they did know and tried to deceive or "take a gamble".

 

So far there's been no answer to that question.

 

 

Yes, they did buy insurance, but for the pre existing condition, they did not


 
 
 
 


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  # 2089539 12-Sep-2018 20:13
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afe66:Rather than muttering about insurance claims being declined and casting aspersions about the industry.

 

Can you please identify where that family was muttering and casting aspersions about the insurance industry? The only aspersions that I am seeing being cast are mostly by posters in this thread upon the family. Really, it's time some of us stop being so nasty. She's dead. Repeating the same boring points ad nauseum is just indecent. 


2997 posts

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  # 2089616 12-Sep-2018 23:55
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kryptonjohn:

Yep. Unless the policy says you have to have the IDL. If they just said you have to be driving legally then your NZ licence does that and the insurer is being dishonest. I expect if any company behaved that way the bad press would hurt them fairly quickly. Certainly I would never go near Youi insurance for this reason (and lots here at GZ have said the same thing) as their reputation is terrible.



I've always thought that the main reason for an IDP was that older NZ licences didn't have photo ID. I know that since the current style I have hired cars in countries that supposedly require an IDP and the rental agency has been happy with just the NZ licence (and the Italian Police but that's another story).

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