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CR351 Exclusions / Causation Pre-existing condition exclusion clause – dispute as to proximate cause of death – whether pre-existing conditions directly or indirectly caused death, or whether death was caused by cancer which emerged after cover commenced Background 1. The insured had a credit insurance policy since 2008, with death and disability cover for the […]Read More
CR320 Causation. See also exceptions, exclusions and waiting periods. Exclusion clause – lumbosacral spinal exclusion imposed – not stated to apply where condition results indirectly from it – claim not therefore excluded. The complainant was covered under two policies for illness and disability. She subsequently injured her thoracic spine after a fall at work and […]Read More
CR176 Causation – exclusion – death resulting from pre-existing condition excluded – whether death was caused by the insured’s pre-existing condition or by an intervening cause Background The insured bought a motor vehicle and took out a policy providing life and disability cover. The policy issued to the insured excluded cover for death arising directly […]Read More
CR175 Causation – exclusion – benefits not payable during “sickness attributable to pregnancy” – whether infection by a bacterium most probably introduced during procedures related to pregnancy is a basis for reliance on the particular exclusion? Background The sad circumstances of this matter were that the complainant was pregnant with twins when it was determined […]Read More