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Denied Claim Even with HIV Coverage
Mar 24, 2005

My current expatriate coverage provides cover for "medical expenses which arise from or are in any way related to HIV, AIDS or ARC and/or any mutant derivative or variations thereof".

However, a few weeks ago, I was admitted to the hospital for in-patient treatment. I was treated for Pneumocystitis carini pneumonia. I also found at for the first time that I have HIV.

When I submitted my claim to the insurance company, my claim was denied. Their reason was that there is a general exclusion that states "the policy does not cover expenses arising from venereal disease or any other sexually transmitted diseases or any related condition".

Notwithstanding that I was treated for pneumonia and did not receive treatment or medication for HIV, can I be denied compensation because the claims reviewer has linked HIV to being a STD, even though the policy specifically provides coverage for HIV and there is no reference in the coverage statement for denial of HIV coverage owing to suspected method of transmission?

Response from Ms. Franzoi

You should file an appeal with the insurer quoting the specific sections that cover HIV-related illnesses.



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