Raymond Thompson, 91, in Hawke's Bay Hospital this year, where he underwent surgery for a broken hip and gangrene.
Raymond Thompson, 91, in Hawke's Bay Hospital this year, where he underwent surgery for a broken hip and gangrene.
Raymond Thompson dutifully paid his accidental death insurance for 17 years, but when he broke his hip and died four weeks later, "screaming in pain", there was no pay-out to his family.
The 91-year-old Napier man's death on April 26 wasn't an accident, according to BNZ Insurances.
Compounding his family'ssense of injustice, the Accident Compensation Corporation paid out $6219 in financial support for Thompson's funeral after judging it a death from an injury.
The cause of Thompson's death in BNZ's opinion "was a result of natural causes" - or rather pneumonia caught following one of his numerous hospital stays in that brief few weeks.
Yet all Thompson's "terrible series" of health events began with the fall that broke his hip on March 24.
The decision to reject his claim has outraged Thompson's daughter, Joanne Smith, who says BNZ's accidental death policy is a "waste of money if not a scam" that will "never result in favour of the claimant".
"We believe that dad did die as a direct consequence of the fall – if he had not had the accident, he would still be with us today," Smith says.
"They're [BNZ] quoted as saying you must die of the event, and this needs to be exposed.
"Because people go out getting insurance thinking, 'if I fall and break my neck or I'm in hospital and I eventually die, at least my wife has got that money to carry on with'. But they don't realise, no you don't."
Smith is challenging the decision by BNZ not to pay out her father's $50,000 claim to the banking ombudsman on principal, and says family finances are not the issue. Thompson's wife died in 2006 and he had no dependants to care for.
In letter to Smith, BNZ said in making its decision it looked at "whether the injury resulted in immobilisation of the deceased and whether this contributed to the pneumonia".
Thompson's pneumonia was the final medical complication following his March hospital stay to replace his hip, which also included an infection and gangrene of the scrotum which required additional surgery.
Joanne Smith of Napier and her father Raymond Thompson, who died in June this year after a bad fall in March. Photo / Supplied
BNZ chief operating officer of insurances, Susan Basile, told the Herald the company "very much sympathises" with Smith, but their claim decision was made with their chief medical officer, who is an independent expert.
"This is a unique and unusual situation, with a lot of different medical factors at play, and the policy, which is no longer available, has a limited scope of cover that made it a more affordable option," Basile said.
"To make sure we get the right outcome in this unique situation we will now be treating this as a formal complaint. We will then work with Jo and our chief medical officer to obtain additional information and we will reconsider the decision."
Napier woman Joanne Smith is challenging BNZ's decision to reject her father's accidental death insurance claim, which she believes "will never result in favour of the claimant".
After breaking his hip on March 24, Thompson was operated on and had a raft of compilations over the next four weeks in Hawke's Bay Hospital.
After being discharged back to Princess Alexandra retirement village, Thompson contracted fourniere's gangrene of the scrotum, for which he underwent further surgery.
Thompson contracted bacterial pneumonia and died shortly after this on April 26, 2019.
Throughout this four-month period, Smith says her father was "the whole time either screaming his head off in pain, or sedated".
"He was either under pain relief, or asleep, or when he did wake up it was 'oh my leg, or my hip' and he was just out to it all the time," Smith said.
Melbourne geriatrician Dr Michael Murray said the frequency with which elderly people contract pneumonia following hospital stays means to treat them as illnesses unrelated to any original complaint or injury is wrong.
"The fact that people spend a lot more time in bed because they're ill, is why we see a lot of hospital-acquired pneumonia. It's very common," Murray said.
"People have got pain after the fall and they're given narcotic analgesia [pain relief] and spending much of their time lying flat, it's much easier to get micro aspiration [moisture] going down into your lungs.
"So in a sense a fall is not a fall. They're inextricably linked. I would have thought if you have an insurance policy - one leads to another like night leads to day.
"You could easily postulate that in the treatment of his hip fracture, and his subsequent time rehabilitating, his analgesia [pain relief] would have set him up for aspiration."
BNZ told the Herald on August 2 that its chief medical officer is now reviewing Thompson's medical records.
Herald financial columnist Mary Holm said disputes over accidental death insurance are not uncommon.
"The premiums are cheap, but that's because very few people die that way," Holm said.
"It's far better to get life insurance that covers death from all causes, even though the premiums will be much higher.
"Insurance problems often arise because of wording in the small print. I think any company selling this type of insurance should make it very clear, in large print, the circumstances in which they will pay up."
Smith believes her father falls into this category.
"I would like to stop this from happening to anyone else," Smith said.
"I was not with dad when he took out the insurance, and I am sure he was not explained the policy in detail."
Raymond Thompson and his grandson.
Jo Smith of Napier holds a picture of her father Raymond Thompson who died in Hawke's Bay Hospital April 2019.
