Case Review: Insurance
Summary of some of the decisions made by the Mediators on some of the complaints received by FMB.
This summary is for information only and should not be used for other purpose.
FMB/LI 0001 Definition of Kidney Failure
The assured was diagnosed as suffering from kidney failure and submitted a claim for critical illness benefit. His claim was declined on the ground that the definition of kidney failure stipulated in the policy was not fulfilled.
According to the policy condition the assured would be entitled for the benefit if the kidney failure had reached end stage and had undergone dialysis or haemodialysis or having had renal transplantation. The assured did not undergo dialysis or renal transplant but had opted for alternative treatment.
According to the medical report the assured's kidney failure had reached end stage and he had been recommended haemodialysis or renal transplant. Taking into consideration that the assured had indeed suffered end stage renal failure and treatment, which would meet the requirement of the policy, had been recommended, the insurers revised their decision and settled the claim.