Fair Go: Invercargill farmer refused trauma insurance payout after going blind in one eye

When is a trauma not a trauma? Tania Mudford learnt the hard way.

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When Tanya Mudford lost sight in her left eye, her claim was denied. Now she's warning others. Source: Fair Go

She had what she thought was a comprehensive trauma insurance policy, but it didn't cover the trauma she suffered out of the blue.

It was early one morning in the milking sheds. She was with her husband "Muddy", on their farm just outside Invercargill.

They were doing a herd test - a mundane job that has to be done, taking hundreds of milk samples and labelling them. They were nearly finished when Tania felt a painful sensation in her cheek. It wouldn't go away.

The next day her eye went blurry. A couple of days later, she woke up completely blind on her left side.

She was in pain, she was scared about what was happening, and doctors didn't know why it had happened.

It affected her walking, and her perception when doing things like pouring. So to Tania, this was undoubtedly a trauma, and she expected it to be covered by the trauma insurance they'd been reliably paying for several years.

A cursory look showed that blindness was covered, and their insurance broker said they were likely to get a partial payout of $15,000.

That was a huge help, as they had to pay to fly to Christchurch to see a specialist for a second opinion, and Tania needed help with relaxing so they bought a spa pool, which seemed to soothe her pain and stress.

Their insurance was a Lifetrack policy with AMP, and the company said they'd have confirmation in one to two weeks.

It was actually two and a half months later when they got a letter to confirm that, contrary to initial conversations, their claim was being declined. They were told the reason was that Tania's condition didn't meet the policy's criteria.

It turns out that blindness in both eyes is covered whatever the cause, but blindness in one eye is only covered if it's caused by injury, not by a medical event.

Tania couldn't believe it, saying, "Loss of sight is loss of sight, and it's traumatic no matter how it happens".

A written response from AMP explained that Trauma policies can't cover every trauma, because then "premiums would go up and cover would not be accessible or affordable".

They justified limiting blindness in one eye to only those events caused by accident, saying "eye injuries are recognised in the medical literature worldwide as a leading, if not the leading, cause for the loss of sight in one eye".

That may be true for the population as a whole, but nearly all eye injuries occur in people who are young and male. They're mostly caused by violence, high-risk jobs and contact sport.

In middle-aged women like Tania, it is almost unheard of for an eye injury to cause blindness.

The Insurance Ombudsman Karen Stevens says: "The general problem in New Zealand, is that most people don't read policies. It's a bit like rental car agreements, who reads them? But we need to, because policies are incredibly specific."

She adds that they have a number of complaints every year about trauma insurance, with people unhappy that their specific trauma isn't covered.

The Mudfords don't think they can be expected to weigh up the risks and benefits of each component of their policy.

When they invested in this insurance, they simply wanted to make sure the basics were covered: going blind or deaf, getting cancer or having a stroke. The big events in life. That's why they feel hard done by.

Tania has gone blind, albeit in one eye, and yet due to the "criteria", her claim won't be honoured. To add insult to injury, doctors still aren't completely certain about the underlying cause of the neuralgia that led to the loss of sight.

AMP states that "Tania's treating specialists believe that she is suffering from a rare inflammatory disease .. which isn't one of the conditions covered by Tania's policy".

However, Tania believes they can't rule out injury 100 per cent, as she had a car accident several months prior.

The Mudfords would like the benefit of the doubt, but Karen Stevens warns that insurance doesn't work like that.

"The insured person is the one who has to prove they come within the policy," she said. 

Tania's claim is currently being reviewed, but she's not holding out much hope. The Mudfords feel the best they can do is to offer up their story as a warning. They say "you really have to weigh up how much you're paying, as you may not be covered for what you think".