RGC 264/1437
This case involved a claim under a private health insurance policy obtained by an employer for an emergency procedure. Issues involved the failure to disclose past medical history where there had been a mistake in a medical report and the insurer had accepted the coverage without requesting information on medical history.
Background
The claimant, a Jordanian national, was covered under a medical insurance policy issued by the defendant. The policy was set to expire on a specified date. On a specified date, the claimant experienced severe lower abdominal pain and bleeding. After a medical examination two weeks later, it was confirmed that she was pregnant.
Due to intense pain, the claimant was admitted to hospital as an emergency case. An ultrasound scan confirmed an ectopic pregnancy, with a ruptured fallopian tube, resulting in internal bleeding. This required an urgent surgical procedure to remove the affected tube.