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这是保险公司给的报告：
You have claimed for medical expenses incurred due to a diagnosis of Polycystic Ovary Syndrome.
We understand from information supplied with your claim that you sought treatment with your GP, Dr Chan, due to Oligomenorrhoea and irregular menstrual cycle. You were then referred for an Ultrasound and lab tests for further investigation. Due to the results of these investigations you were diagnosed with Polycystic Ovary Syndrome.
In order to consider your claim, we initially referred to the following section of our policy wording;
If, as a result of an Unexpected Event, You require medical treatment during Your Journey, We will reimburse You for Actual and Reasonable Medical Expenses incurred, or We will confirm payment for a qualifying hospitalisation claim. You, or someone acting on Your behalf, must contact Southern Cross Emergency Assistance if You require hospitalisation or surgical treatment during Your Journey
(1.1 Medical & Evacuation, page 23)
Documentation submitted with your claim advised that since your menarche, your menstrual periods have always been irregular, varying from 1-3 months. Following the receival of this information, it was required that further clarification was needed from your GP, Dr Foong Yeen Chan, in relation to the diagnosis of Polycystic Ovary Syndrome and your medical history of Oligomenorrhoea and irregular menstrual cycle. The following question was presented to your GP;
‘In your opinion, on the balance of probabilities, is the diagnosis of Polycystic Ovaries related to the diagnosis of Oligomenorrhoea and irregular menstrual cycle?’
Below is the response provided by your GP, Dr Foong Yeen Chan.
‘An presented with Oligomenorrhoea, Irregular Menstrual Cycle with prolonged periods of Amenorrhoea and her Pelvic Ultrasound Scan on 15/01/2018 has shown Polycystic Ovaries.
Although her Testosterone level is normal, she has two out of three diagnostic criteria based on the Rotterdam diagnosis of Polycystic Ovary Syndrome. Hence she does qualify for the diagnosis of Polycystic Ovary Syndrome.
In Polycystic Ovary Syndrome, patients have hormonal imbalance causing irregular menstrual cycles, oligomenorrhea, amenorrhoea/anovulation.
Hence in my opinion, on the balance of probabilities, her diagnosis of Polycystic Ovaries is related to the diagnosis of Oligomenorrhoea and Irregular menstrual cycle.’
Under the policy;
We will not pay for any claims under any section of this Policy arising directly or indirectly from Pre-Existing Conditions.
(General Exclusions of this Policy Applying to All Sections, page 20)
Please note;
Pre-Existing Condition: in relation to each person named on Your Certificate of Insurance, any medical or physical conditions, (including congenital conditions, anomalies or defects but excluding congenital blindness and deafness), symptoms or circumstances which You are aware of, or a reasonable person in Your circumstances ought to have been aware of:
for which advice, care, treatment, medication or medical attention has been sought, given, or recommended; or
for which You are awaiting test results or further investigation, specialist treatment or specialist consultation; or
which have been diagnosed as a medical condition, or indicative of a medical conditions; or
which are of such a nature to require or which potentially may require medical attention; or
which are of such a nature as would have caused a prudent, reasonable person to seek medical attention.
prior to Your Start Date of Insurance and regardless of whether or not a medical diagnosis has been made; or
which are not Covered Conditions; or
which have been excluded during the application process; or
for which You have chosen not to seek cover for, or do not tell Us about, at the time of completing Your application.
(Definitions, page 14)
Under the terms and conditions of the International Student policy, we will not pay for any claims arising from Pre-Existing Conditions. Our definition of a Pre-Existing Condition includes any medical or physical symptoms which you were aware of, and for which are of such a nature to require or which potentially may require medical attention prior to Your Start Date of Insurance.
As you had the symptoms of Oligomenorrhoea and irregular periods, which is a symptom of Polycystic Ovary Syndrome, before you came to New Zealand, we consider this to be a Pre-Existing condition and we are unable to accept your claim on this occasion.
We are sorry we are unable to bring you better news.
We understand this may not be the outcome you were hoping for, however please know that we have carefully considered your claim according to the terms and conditions of the policy. |
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发表于 2018-3-29 19:26:08
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