Bank pays out half of claim in recognition of circumstances beyond customer’s control

Categories:
Insurance policies,
Summary:
In 2018, Mereana took out an insurance policy from the bank. The policy offered limited benefits in the event of redundancy, accident or illness. In October 2023, Mereana was made redundant. Shortly afterwards, she made a claim under the policy for redundancy and saw her doctor for stress (and was declared unfit for work for 12 weeks). The bank declined the claim on the basis that she was not "actively seeking work".
Published:
November 2024

Mereana said it was only because she was unwell that she was not looking for a job. She also said the Ministry of Social Development was satisfied she qualified for a job-seeker benefit despite being off work for 12 weeks. She complained the bank was not applying the policy fairly, but the bank would not change its mind.

Our investigation

We reviewed the policy and found it said unambiguously that Mereana had to be "actively seeking work" to qualify for the redundancy benefit, and it was beyond dispute she was not actively seeking work. However, it was equally apparent her inability to work was the result of circumstances outside her control – circumstances that made her particularly vulnerable. Mereana had paid her policy premiums without fail, and there was no question about the genuineness of her situation or the fact the redundancy benefit was only payable for a limited period only, rather than indefinitely. We encouraged the bank to review its decision, taking into account Mereana’s vulnerability and circumstances.

Outcome

The bank offered Mereana $3,308.61 equivalent to half the value of her claim. She accepted the offer.

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