health insurance definition

shiwen55

Hi,


To cut the story short, I have recently joined HSF (hospital Saturday fund) through my employer, great !!


It says there is a weekly payout for temporary disablement up to 52 weeks following an 'Accident' and unable to work, either policyholder or partner and no children under 16 years, that's fine ..


My wife has recently developed swollen wrists and hands are puffed up from lifting heavy grocery items at where she works (she's a cashier at local supermarket). Now, my question is, can this be classified as an accident? I want to find out, before asking the insurance company for guidance, obviously not a good idea !!


Thank you,


shiwen55

FutureGirl

You would need to read the definition of 'accident' within the policy document, but that isn't something I would class as an accident.

How long has she been off work for due to this? Is she receiving sick pay?

Has this occurred before? If so, likely to not be covered due to pre-existing.

shiwen55

Hi,


No, first time and she's still working but it's getting worse every day, we have even gone private for physiotherapy ..


She has never been entitled to any benefit, even when she was looking for work, because of my income. They said my wages is more than a couples benefit (what??!!) so she would get nothing, not even the difference.


It doesn't say much on documents, that's why I don't want to call these guys


Thanks

FutureGirl

Your policy documents will tell you the definition of an 'accident'. An 'accident' is usually a one off incident - what you describe is an on-going issue.

The weekly benefit only applies if she is not able to work... but your OP notes she is still at work, therefore she wouldn't be entitled to claim.

rs65

Accident means a sudden unforeseen and fortuitous
identifiable event and the word accidental shall be
construed accordingly.