Mason’s estate complained to us because his insurer declined the estate’s claim under his personal accident policy.
What happened
Mason’s estate complained to us because his insurer declined the estate’s claim under his personal accident policy.
Mason had an operation to remove a lump on his neck. During recovery, the wound started to bleed profusely, resulting in a massive haemorrhage. As a result of this, Mason had died.
The insurer rejected the claim because it said Mason’s death had resulted from the complications of planned surgery – rather than from an accident.
What we said
We considered the medical evidence carefully. In this instance, there was nothing to suggest that what had happened to Mason was an accident. The medical reports and coroner’s inquest cleared the surgeons of any wrongdoing and found that no error had occurred during the operation. Mason was just one of the very few unfortunate patients who reacted badly to this type of surgery.
We felt the injury that led to Mason’s death was a natural, albeit tragic, consequence of his surgery. It was an anticipated risk that Mason had consented to the general risks of surgical complications had been explained to him. We couldn’t conclude that an accident had taken place to bring Mason’s death within the policy terms.
Despite sympathising with Mason’s estate, we couldn’t agree the insurer had acted unfairly or unreasonably. So we didn’t tell the insurer to pay the claim.