Policy rewrites redefine heart attack definition
A secret settlement in a battle between a heart attack victim and her insurer is driving an industry shift towards a fairer definition of what constitutes a serious heart attack.
Many insurers have moved to alter their definitions following a confidential settlement a little over three years ago between an insurer and a female heart attack victim, said Naomi Ballantyne, chief executive of insurer Partners Life.
Another insurer, Asteron, said the changes could result in payouts in 50 per cent more cases than under the old definitions.
But consumers beware: not all insurers have changed their definitions.
Ballantyne said the woman who accepted the confidential settlement had suffered a serious heart attack.
"She was in hospital for three weeks, but the insurance company refused to pay because it didn't meet their exact wording."
One of the world's best cardiologists was on the claimant's side, and even though her heart attack did not pass the enzyme elevation test which the insurer required, it decided to make a payment to her, Ballantyne said.
The confidentiality surrounding the settlement, which kept other policyholders who might have had a similar grievance from learning about it, began a wave of change that has brought about better cover for many policyholders.
Partners Life and others adopted a definition allowing the company to consider "other appropriate tests and any other medical evidence or specialist opinion" in cases where the two traditional tests - for enzyme elevation and changes in the heart measurable by electrocardiogram (ECG) - were inconclusive.
Asteron and Fidelity Life are among them, as is Onepath, which is behind the ANZ's Lifestyle insurance policies. Others such as Westpac Life, Cigna and BNZ have not yet added a flexibility clause.
Fidelity Life's general manager for operations, Neale Watling, said another definition has not yet disappeared.
That requires a claimant to have had a history of chest pain, but Watling said many heart attacks came out of the blue.
BNZ's Lifecare policy, for instance, still says there "must" have been "a history of typical prolonged chest pain".
The Sunday Star-Times has written about the issue before and it features in complaints to the Insurance Ombudsman. It surfaced again last week in the story of a former insurance broker from the South Island facing multiple criminal dishonesty charges.
Barry Hansen, who maintains his innocence, is set on revealing abusive behaviour by insurance companies. He said many policyholders have simply accepted the line that they are covered for heart attacks, and never realise that when one strikes it may not trigger a payout.
Hansen has a personal interest in the issue as he has developed the rare coronary artery spasm condition, which he says presents as a heart attack, is debilitating and requires ongoing medication and periodic hospitalisation. To his shock, he was not covered by the Sovereign policy he sold himself.
Not everyone accepts that the confidential settlement has been the driver of change towards a fairer definition. Asteron's Nadine Tereora, executive manager for underwriting and claims, said it changed for a different reason.
"It was more about supporting quality of life for customers who have survived traumatic events, and about closing the gap between the insurance definition of heart attack and people's experience of them," she said.
It was also an acknowledgement that there was a big gap between the insurance definition of a heart attack, and that of the medical profession.
Tereora said there had been moves overseas to narrow the difference between insurers' and clinicians' definitions of a heart attack. Those moves influenced New Zealand insurers when they were negotiating their reinsurance.
~ Cardiovascular disease is the leading cause of death in New Zealand, accounting for 40 per cent of deaths annually.
~ Every 90 minutes a New Zealander dies from coronary heart disease.
~ One in 20 adults has been diagnosed with coronary heart disease. That's 161,000 adults including 89,400 who have had a heart attack resulting in them being hospitalised.
~ Women who smoke risk having a heart attack on average 19 years earlier than non-smoking women.
~ Nearly two-thirds of the deaths from heart attacks in women occur among those who have no history of chest pain.
~ 42 per cent of women who have heart attacks die within a year, compared with 24 per cent of men. Heart attacks in women under 50 are twice as likely to be fatal as in men under 50.
Source: NZ Heart Foundation
Sunday Star Times