A lawyer says Long Covid sufferers are increasingly seeing their insurance claims denied using mental health exclusions.
The 2024-25 National Health Survey found more than 400,000 people reported having Long Covid-19 symptoms, defined as ongoing symptoms that continue for more than 12 weeks after having had the virus.
Insurance lawyer Tim Gunn told RNZ’s Nine to Noon programme on Wednesday that people were being declined income protection claims when they were unable to work.
"These people are doing the right thing from the start. They are going through the process of applying for insurance and filling out the various insurance application forms.
"As part of that process, you're required to disclose diagnosed conditions or issues that you've experienced in the past. These are kind of pre-existing conditions."
Gunn said his clients diligently did that process and disclosed an incident of mental health in their lives, which resulted in a mental health exclusion applied to their policy.
He said the policy would run for several years before his client got Covid and Long Covid, and were then unable to work.
"(They) then go to apply for cover and find that the mental health exclusion that was applied at the start of their cover isn't a mental health exclusion.
"It is an exclusion that applies to both mental health conditions and others."
The mental health disclosure was the cause of the imposition of the exclusion, Gunn said.
He said insurance policies did not have a defined list of illnesses and there was no automatic exclusion on an income protection cover. The exclusion was not limited to the illness that you disclosed - it was a broad and all-encompassing mental health exclusion.
Gunn said insurance providers did not consider Long Covid a mental health condition.
"They are distinctly confirming that they do not believe that Long Covid is a mental health condition, but that this mental health exclusion doesn't just relate to mental health conditions.”
He had seen similar nuance applied for people who disclosed ADHD.
Gunn said his position was that when someone disclosed a mental health condition that they had experienced in the past, it was "reasonable and proportionate to put a justifiable limit on their ability to claim into the future for that condition or conditions that were directly related to what they disclose".
"It is not proportionate and reasonable to put a blanket mental health exclusion that covers both mental health conditions and non-mental health conditions - because in effect they are saying, because the words disorders related to fatigue exist in the mental health exclusion, that they can cover claims relating to issues where the symptoms are fatigue related."
Gunn said the exclusion was a mental health exclusion and the condition that insurance providers were excluding was a non-mental health condition and therefore was unreasonable.
His clients had tried to dispute it.
"There are pending reviews, but people are spending years in review processes where the insurer is accepting that they are disabled, accepting that they cannot work, accepting that they cannot work due to the profound impacts of this condition, but that the mental health exclusion was wide enough to capture this non-mental health illness.”
Gunn said there were various legal arguments as to how you interpreted the words of a policy. There were insurance-specific rules which related to how you interpreted the clauses.
"There are various contractual arguments as to how those words should specifically be interpreted in this context. Those arguments are live and we can explore those. There are the arguments in terms of the fairness of those conditions and if they comply with the Human Rights Act in terms of the carve-out for insurers.
"On a pure contractual basis, we can argue about what the words actually say, and then we can talk about the broader fairness issues."
Insurers defend policy assessment processes
In a statement, Partners Life said it did not regard Long Covid as a mental health disorder, but recognised it as a post-infectious condition that could affect multiple body systems like fatigue, post-exertional symptoms and cognitive difficulties.
It said it had accepted claims for customers with Long Covid, including customers with exclusions for, among other things, mental health disorders.
It also said as part of its assessment process, Partners Life considered whether an individual claim sits within the policy wording conditions.
Financial Services Council said it wasn't in a position to comment on individual claims or decisions made by insurers.
