CR283
Interpretation

Claim declined – policy covering cancer of “the genitals including cervix, uterus, vagina and vulva” – insurer contending that complainant’s ovarian cancer not covered.

Background

The policy was described as a “Cancer Protection Plan for Women” and the insurer undertook to pay the benefit for:

“Positive diagnosis of cancer in the breast or genitals including cervix, uterus, vagina and vulva”

The complainant developed ovarian cancer, but the insurer rejected her claim under the policy. A gyneacologist who she had consulted confirmed that the ovaries form part of the internal genital system. The insurer contended that the word “including” limited anything beyond the genitals themselves to the cervix, uterus, vagina and vulva.

Assessment

It was the view of the Ombudsman that the word “including” does not mean “limited to”. In this particular instance the word “including” fell to be interpreted as meaning that all genital cancers are covered including, but not limited to, the cervix, uterus, vagina and vulva.

Result

The Ombudsman made a provisional determination in favour of the complainant which the insurer accepted, and the matter was settled in the complainant’s favour.

DMcK
October 2009