Medical Health Insurance

An insurer must fairly apply chronic condition exclusions based on the actual medical evidence and circumstances, not on a selective interpretation of information.

An insured person must establish that they meet the specific policy definition of incapacity throughout the relevant period; being signed off work by a GP is relevant but not determinative.

Insurance policy terms must be interpreted according to their plain language meaning, and optional cover does not override explicit exclusions in the main policy.

An insurer must handle claims promptly and fairly, and cannot unreasonably reject a claim, but may request written documentation for complex claims.

An insurer may reasonably reject a claim for routine follow-up consultations that fall within explicit policy exclusions, provided the rejection is not unreasonable.