• Following the comments of the President of UOKiK, Compensa TU na Życie S.A. Vienna Insurance Group has decided to change the current definitions of the ICU and stay at the ICU.
• Under the new definition, the insurer's liability will cover events that occurred due to a sudden, severe health collapse and resulted in the insured person undergoing intensive medical treatment also in units other than the ICU, such as cardiology.
• Compensa will also reconsider benefit claims (submitted from 2018 onwards) that the company previously rejected due to the wording of the existing definitions.

The Office of Competition and Consumer Protection received a complaint concerning the refusal to pay a benefit by Compensa Towarzystwo Ubezpieczeń na Życie S.A. Vienna Insurance Group. The consumer's insurance covered, among other things, a stay in an Intensive Care Unit (ICU). However, he found himself in the Cardiac Intensive Care Unit.

As the insured indicated in a complaint, describing his hospital stay: "To be more precise, there was a separate cardiac intensive care room fitted with specialised equipment to continuously monitor basic vitals, intended for patients under the care of medical specialists. (...) I have attached documentation, which contains information that I had stayed in such a unit. I was under the constant supervision of intensive care specialists while anesthesiologists were there to ensure the accuracy and continuity of treatment."

Meanwhile, as defined in the company's General Terms and Conditions of Insurance (GTCI), Compensa required that the insured person be under the continuous care of anesthesiologists and intensive care specialists and not be in a cardiology, neurology or diabetes unit.

"Such definitions exclude from coverage individuals who suffered an unexpected life-threatening health collapse but have been classified for treatment directly in a specialised unit, without having to stay in the ICU. Currently, an increasingly applied life-saving procedure involves a practice, which assumes that a patient with, for example, a pre-existing heart condition is immediately referred to the cardiology unit in a hospital where they receive intensive cardiac therapy in the event of a sudden deterioration of health. That is why such a patient needs to receive help from specialists in a given field who have the knowledge and appropriate equipment to save his or her life as soon as possible," says Tomasz Chróstny, President of UOKiK.

The President of UOKiK noted the imprecise content in Compensa's existing ICU definitions and appealed for their change. In consultation with the Office of Competition and Consumer Protection, Compensa presented new definitions that no longer require that the insured person must remain under the supervision of anesthesiologists and intensive care specialists during treatment, nor do they exclude the insured person from undergoing intensive care treatment in other units, such as cardiology, neurology and diabetes. The company will amend the definitions contained in the GTCI by the end of this year at the latest and will be processing benefit claims under the new wording from now on.

Compensa has also agreed to provide notice to all insured persons whom, as of 1 January 2018, the company denied benefits due to the wording of the aforementioned existing definitions, containing information that they may file a request for reconsideration of their claims. The notices are currently being sent. Compensa will handle the submitted applications by 13 September 2021.

Consumer assistance:

Phone: 801 440 220 or 22 290 89 16 – consumer hotline
E-mail: porady@dlakonsumentow.pl
Consumer advocates – in your town or district

Additional information for the media:

UOKiK Press Office
Pl. Powstańców Warszawy 1, 00-950 Warszawa, Poland
Phone +48 695 902 088, +48 22 55 60 246
E-mail: biuroprasowe@uokik.gov.pl
Twitter: @UOKiKgovPL