Family told by insurer that saving their baby daughter is ‘elective’

An Aussie family has been told by their insurer that surgery to save their daughter is ‘elective’.

Family told by insurer that saving their baby daughter is ‘elective’

Elise Anderson is only one-year-old. In her short life, she has suffered numerous health issues that have led to surgery and other medical dramas, the latest of which is her family learning that her liver is completely beyond repair.

Her father, Glenn, is prepared to give her part of his own liver, which would mean that baby Elise would not have to go on a long transplant waiting list. It would also mean she has less chance of dying while she waits.

It’s a no-brainer for Glenn. What parent wouldn’t do the same. It seems that only his insurance company is against the idea.

According to his income-protection insurer: "The elective surgery benefit is a non-super benefit so unfortunately it will not apply to this policy".

This brings to light the fact that most insurers would treat this issue the same way, unless your income-protection insurance is not linked to your superannuation fund.

This line of thinking doesn’t make it any easier to stomach, especially for a father who just wants to save his little girl’s life.

"I feel like I've asked the insurance company for a million dollars, not approximately eight weeks’ part-pay out of a possible 12 weeks off work to save my daughter's life," Mr Anderson told Fairfax Media. "We're asking: why are we paying at all? $3000 a year for the last three years goes a long way."

Income-protection insurance replaces up to 75 per cent of a person’s income if they are unable to work. In 2007, rules were introduced that allowed people to receive insurance payments from their super fund. It’s less-expensive to do this, and has a host of advantages, but one disadvantage is that elective surgery is not included under insurance in super.

In the Anderson case, they can’t just switch to a non-super insurance fund now. Even after a six-month wait, Mr Anderson will need to undergo full underwriting which will mean the operation will be excluded from his insurance.

As a result of this story, the lesson for many Australians may be to dump income protection within super, or retaining it for cash-flow benefits but have a separate policy that covers the benefits excluded by insurance within super.

That knowledge doesn’t help the Anderson family now. It does, however, raise an interesting point: why is live organ donation for the purpose of saving a family member considered ‘elective’ surgery? Especially when, to most of us, saving a family member is not an option.

Michael D’Apice from Austbrokers Financial Solutions sums it up best: "If an insurance company doesn't have the moral backbone to look at this as an individual situation, then they're not standing on a high moral ground, let's just say. We are now seeing so much push back from insurance companies; so many times the default is to just deny the claim."

After the insurer, Asteron, was contacted for a comment about this story, it is apparently open to allowing a payment to the Andersons.

"We are talking to Mr Anderson and his adviser to assist him and his family about this matter," said an Asteron spokesperson.

It would be lovely to see the insurer do the right thing. Fingers crossed.

Read more at The Age

What do you think of this situation? Do you think that instances such as these should be judged on individual merit? Do you think your insurer is ethical?

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    COMMENTS

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    20th Jul 2016
    11:20am
    Normal behaviour from the insurance industry. Glad I left it 40 years ago.

    Given my now more advanced years, my personal gripe with income protection insurance is that it's unavailable once you turn 65. Pretty unacceptable given the way retirement ages are heading.
    HarrysOpinion
    20th Jul 2016
    12:26pm
    Income Protection Insurance is crap anyway. Firstly, it covers you only for 3 months for involuntary loss of your employment Secondly, there is a gap of few weeks wait from time of your claim. Thirdly, when payment is approved you have to wait 30 days to get paid. Fourth, if payment is designated to cover your finance loan, by the time the payment gets to your creditor, the creditor charges you a late payment fee, even though you communicated with the lender and advised them of the reason and that you have a Income Protection insurance to cover 3 months payment. Yes, the same lender who sold you the Income Protection Insurance in the first place. It's just a bloody rip-off!
    Rosret
    20th Jul 2016
    1:12pm
    I haven't heard a good story from income protection insurance yet. A dying colleague put into income insurance all his working life was denied any reimbursement until he had used all his company sick leave and holiday pay. He thought he had been paying into the insurance policy to protect his family. All he had done, was like this gentlemen, was waste thousands of dollars that could have gone to the cost of chemotherapy.
    Gammer
    20th Jul 2016
    2:17pm
    When my husband passed away his life insurance company denied the claim saying he had a pre-existing condition (Type 2 diabetes) when he took out the policy... Yes, we had overlooked this, but we had simply upgraded our insurance (on the advice of our financial adviser who had filled out and submitted all the documentation on our behalf) with the same company after having the original policy for about 18 years... Had our financial adviser not advised this (no doubt he was just looking for his commission on the new policy) the insurance company would not have had any grounds to refuse... At the very least I felt the insurance company should have stood by the original, old, policy but of course they just wriggled out of the whole thing!!! I promptly cancelled my own life insurance that I had with them.
    Cat
    20th Jul 2016
    10:50pm
    I regularly get phone-calls from banks and insurance companies trying to sell me income protection insurance as an add on to what I already have with them. When they give me the spiel about how cosy and secure my income would be if I took it out, I just give them the reverse spiel of all of the ways that these companies consistently refuse to pay claims so that I could never possibly feel secure about my income protection. I also tell them how great it feels to have protected my income from being wasted of their product.
    HarrysOpinion
    22nd Jul 2016
    4:36pm
    Yeah, you got it right Cat. You ticked the box.
    tactful
    21st Jul 2016
    10:10pm
    The Insurance Company is actually correct. There is nothing wrong with the father's liver and having surgery to remove part of it would be elective.
    Perhaps the specialist treating his daughter could treat him as a public patient which means he would have his surgery under Medicare, or they could all do it pro bono.
    Anonymous
    22nd Jul 2016
    5:19am
    You have missed the point of the story completely. Please read it again.

    The cost of the surgery is NOT the issue. It's about eight weeks pay.
    Eve
    24th Jul 2016
    2:47pm
    What is the name of this insurer. We need to know that in a life and death situation, they clearly regard death as an option. WHO WAS IT?

    Particularly offensive given the thousands and thousands of insurance ads accusing you of not loving your family if you don't have life, funeral, income protection, health and god knows what other kind of insurance. Remember the 4 year olds that ask their dads what they will do if dad dies or loses his job? And now we know the insurance is as crap as the advertisements.
    Anonymous
    24th Jul 2016
    2:57pm
    The insurer is Asteron. (Which is part of Suncorp.)

    It's named near the end.