Insurer denies cover to save baby

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?

Related articles:
Insurance accidents – your rights
Insurance premiums on the rise
Making an insurance claim

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