Dave’s melanoma claim

Dave was diagnosed with a melanoma that technically didn't meet the policy definition of Cancer. But after a review of his claim he was still able to receive valuable financial support.

10 years after taking out his trauma and income protection covers, Dave developed an unusual melanoma on his left eye.

In these instances, to claim on his policy, Dave would need to meet the policy definition of Cancer.

This definition is:

Cancer means the presence of one or more malignant tumours including leukaemia, lymphoma and Hodgkin’s disease characterised by uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue. Melanomas are covered if they:

• Have evidence of ulceration; or
• Are at least Clark Level 3 depth of invasion; or
• Are at least 1.5mm Breslow thickness, as determined by histological examination.

As cold as these medical definitions may appear, we’re required to write medical definitions for our policies – not to find ways of getting out of claims – but rather, to be able to clearly identify those people who are impaired by their unfortunate circumstances, and whose claims are legitimate and need to be paid. The Clark Level and Breslow thickness are two measurements that are applied to determine the severity of a melanoma.

Dave rightly claimed on both his income protection and his trauma cover. ‍

Although it takes time to assess a claim properly, we began paying his monthly income protection benefits immediately to ensure he had some financial support during this difficult time.

At OnePath, there are people in our business who make human decisions on our claims, and while they use the policy definitions as a starting point, they have the intention of paying all legitimate claims that are aligned with the purpose of the product – to get people back to the financial circumstance they were in before the unfortunate event happened.