When is a heart attack not a heart attack?

In Australia a TV network alleges that an insurance company’s definitions and claims underwriting are too tough. Whether or not that is the case is not possible to say without looking at an awful lot of detail. It is probably best to leave that judgement to the review process which is going on in Australia at the moment.

What I would like to focus on instead is a general principle in definitions used in insurance – that what is generally accepted as the definition of a term, such as ‘heart attack,’ should always be the main guide for defining it in the policy document.

If we do not use this as a guideline we can have difficult situations emerge. Picture a video in which the claimant tells the story of his heart attack, which happened while surrounded by medical professionals. He tells the story of how he was hooked up to monitoring devices when the doctor told him that he was having a heart attack. He relates – terrifyingly – how he heard the heart monitor flat-line. The next thing he remembers is coming back to consciousness. He was told that he had just had a serious heart attack. He was told that he was very lucky it only took one attempt to resuscitate him.

They then explain that his claim was declined.