Claim case sharing
Quality service comes from a customer-focused attitude
With a customer-focused attitude at the heart of our corporate values, MSIG bases the grounds for claims compensation on the underwriting intention rather than the literal meaning of policy wording to ensure customers enjoy the full protection of their cover.
As one of the leading general insurers in the market, MSIG's assessments are highly sought after by industry bodies as a second opinion. What follows is a clear demonstration of how we consider insurance cover from a customer's perspective, using a travel claim rejected by another insurer as an example.
Mr. Cho joined a cruise land tour in Singapore during which he fell and fractured his right ankle. He received initial medical treatment at the medical centre on his cruise ship during which a walking boot was fitted to prevent further injury. When he was transferred back to Hong Kong, he underwent an operation followed by hospital recuperative care.
In due course, Mr. Cho submitted his medical expenses claim to his travel insurer. However, expenses related to the use of a walking boot were declined on the grounds that "devices such as wheelchairs and crutches that were not used during hospital confinement" would be excluded from the policy.
The ICCB referred this case to us for our advice. The walking boot is traditionally regarded as a brace, but in Mr. Cho's case, we believe the walking boot was used to prevent additional short-term injury pending his repatriation for an operation at a Hong Kong hospital. Additionally, as the accident occurred during a cruise, Mr. Cho could not have been quickly transferred to a Hong Kong hospital. Preventing the injury from getting worse was essential. In cases of this nature, the walking boot's purpose of usage is different from the original underwriting intention to exclude any medical devices for prolonged use.
Having taken everything into consideration, we concluded that compensation for the expense of the walking boot was appropriate in this claim adjustment.