Woman questions Prudential executive in lawsuit seeking brain surgery payout as insurer responds
Ms Cai Yunhong questioned the Prudential executive, who is head of life claims, on the way her policy documents were drafted, alleging that they were "convoluted" and "full of ambiguities".
The State Courts of Singapore (File photo: CNA/Jeremy Long)
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SINGAPORE: A woman who is suing Prudential Assurance Company Singapore for a payout of more than S$100,000 (US$78,500) for brain aneurysm surgery on Tuesday (Apr 28) questioned the insurer's head of life claims on the language used in her policy documents.
Concurrently, Prudential issued a statement on the case for the first time, saying that it had sought to resolve the matter with the woman to no avail.
The claimant, 45-year-old Cai Yunhong, had a stroke in 2023 from a ruptured aneurysm and underwent endovascular repair, which is not covered under the policy she purchased.
She alleges that Prudential denied her claim in September 2023 because of a "single, buried clause" that defined brain aneurysm surgery as only the open-skull procedure of surgical craniotomy, a procedure she said was riskier and more invasive, with higher mortality rates.
Ms Cai, also known as Tania, claims that Prudential "manipulated" the language of the contract "with the sole purpose to make financial gains".
On Tuesday, Ms Cai questioned Ms Tan Kah Tin, head of life claims at Prudential, on the language used in her policy documents.
She had purchased an early critical illness policy from Prudential after being approached by Standard Chartered Bank in 2016.
This was the Prulife Multiplier insurance policy with financial protection against death, disability, terminal illness and critical illness, with an early crisis cover multiplier supplementary benefit that provides a higher payout.
Ms Cai put it to Ms Tan on Tuesday that there was no glossary section in the front of the policy documents clearly defining certain terms.
Instead, the exclusions were found only on a "single page" in the last section of the documents, Ms Cai claimed.
The judge interjected at several points to query what exactly Ms Cai was asking.
At one point, Ms Cai said: "My claim is the policy is so convoluted and full of ambiguities. That is my claim. What I'm trying to establish is that if the express terms of the contract must be followed to a T, then no claims would be passed through."
Ms Cai also showed Ms Tan a section from the policy documents and asked if she agreed that endovascular surgery for stroke was not listed as an exclusion there.
Ms Tan agreed, but added that it was not listed because her claim was under another section which was under a different clause, pointing out where that could be found.
Ms Cai also asked why the "same plain English" used for heart aneurysms was not used for brain aneurysms.
In response, Ms Tan said she could not comment as she was not the drafter of the policy documents.
PRUDENTIAL RESPONDS
Prudential, which is represented by a team of lawyers led by Mr Joavan Pereira from Virtus Law, had said that Ms Cai's claim is "meritless" as the contract stated unequivocally and unambiguously that the type of surgery Ms Cai underwent would not entitle her to payment of the lump sum benefit she was seeking.
Prudential said in a statement to CNA on Tuesday that it could not comment specifically on Ms Cai's case as the matter was ongoing.
It stated that insurers had different approaches to covering endovascular repair in 2016 and that Prudential had excluded it, as had some other insurers.
Prudential said that some of its critical illness policies, including its latest plan launched in March 2026, now provide coverage for the procedure Ms Cai is seeking a payout for.
The trial continues before District Judge Teo Guan Kee.
