Adapted from https://www.stuff.co.nz/business/money/130677664/woman-loses-home-after-insurer-turns-down-brain-tumour-claim
When Amber Denney bought life and critical condition insurance from Bank of New Zealand, she thought it would help pay her mortgage, if she ever fell so seriously ill she could not work.
But when she contracted a debilitating and life-threatening brain tumour, BNZ’s insurance proved worthless.
Denney was diagnosed with a pituitary tumour in 2020, and underwent brain surgery, several years after symptoms emerged, including rapid weight gain, muscle loss, brain fog, fatigue, depression and severe headaches.
But despite her neurosurgeon saying Denney fitted the criteria to succeed in her $52,000 claim, BNZ Life Insurance declined the claim, after taking six months to come to a decision.
As a result of her illness, Denney was unable to work, and lost the home she bought when she was 21. She wonders to this day, if the insurance money would have allowed her to save it.
At a time Denney, now aged 26 and renting in Hamilton, was losing her home, banks were working to make sure people did not lose their homes in the economic disruption of the Covid-19 pandemic.
BNZ refused to comment on whether the insurance it sold had failed Denney in her time of need. But Partners Life, which bought BNZ Life Insurance after her claim was decided has promised to take a fresh look at her case.
Denney has yet to concede defeat to her insurer, and may take a claim to the Banking Ombudsman claiming service failure by BNZ, and the Insurance and Financial Services Ombudsman over the decision by BNZ Life to decline her claim.
But she says she is speaking out to warn others that their insurance may be much more limited than they think, and fail them at their time of direst need.
Her cluster of debilitating symptoms resulting from the pituitary tumour is called Cushing’s Disease.
“I’m not the only Cushing’s person who has had this trouble with the insurance companies,” she says.
“The endocrinologist told me about all the other people who have been struggling,” says Denney, who before her illness was fit enough to climb mountains and shear sheep.
There were several critical failures of the critical condition insurance BNZ sold her, according to Denney and insurance lawyer Tim Gunn, who is helping Denney pro bono.
While the BNZ Life policy did cover pituitary tumours, there were two caveats.
First, it had to produce neurological damage, and functional impairment, which a specialist considered to be permanent.
Second, it had to be removed by a craniotomy, surgery that requires cutting through the skull.
Gunn says the requirement for a craniotomy is unreasonable, unfair and outdated.
In recent decades the primary surgical option for pituitary tumours was not a craniotomy, but keyhole surgery, which was used to save Denney’s life.
“The method of surgery to remove the tumour was the most current and accepted method,” Gunn said, and was now used in 95% of pituitary tumour surgeries.
Craniotomy surgery carries a higher risk and was not as effective, he says, and requiring it was unreasonable.
But Denney and Gunn say the policy was also fatally flawed because it could not do what she was sold the policy for in the case of a policyholder contracting a pituitary tumour.
It takes so much time for medical specialists to conclude that damage is permanent after an operation, that paying a claim in time to help save a policyholder’s home is not possible, Denney maintains.
One communication from BNZ Life dated September 2021, told Denney that despite her being diagnosed in July 2020, operated on in September 2020 during the level 4 lockdown, proof of permanency had still not been established.
Denney says she has been left with permanent memory loss, severe headaches, and other symptoms of Cushing’s Disease, and can’t understand why BNZ Life is not paying.
“It’s blatantly obvious. I’m struggling. I just don’t get it. It’s extremely unfair,” she says.
“BNZ has failed in their responsibility to ensure that Ms Denney was adequately protected,” Gunn says.
Denney says one horrified BNZ worker told her not to let the bank win.
“She advised me, it was her exact words, ‘If you have the energy to fight, fight them until the end’,” she says.
BNZ would not answer the allegations, saying only that all BNZ Life’s records had moved to Partners Life, though Denney remains a BNZ customer.
BNZ had sold the business to Partners Life, which has in turn been sold to Japanese insurer Dai-ichi Life.
Partners Life has promised to review the decision taken by BNZ Life to turn Denney’s claim down.
It said BNZ Life’s conclusion was that while the condition Denney suffered was most certainly traumatic, it was not covered under the definitions in the policy wordings.
Critical condition (often called critical illness) insurance was not designed to cover every possible health emergency, it said, but did not comment on the specific allegations Denney and Gunn have made, as it had only been alerted to them by Stuff.
It said it would contact Denney about the review of BNZ Life’s decision to decline her claim.
Partners Life says its claims philosophy is that, “if it’s grey, we pay”, and “where the medical information is unclear or conflicting, we will remove the uncertainty and simply pay your claim”.
Denney said her surgery saved her life, and her weight has dropped by 35kg.
Doctors told her in 2020 that without the surgery she would have two years to live.
“I’ve passed that two years now, so every day’s given to me now,” she says.
At its worst, Denney’s symptoms were so bad, she was unable to work for nearly two years, though her life is on the up, and she is once again dreaming about buying a home.
She has landed a job at a supportive employer in Hamilton.
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