Polly, a five-year-old, underwent cochlear implant surgery to treat severe to profound bilateral sensorineural hearing loss. Her mother, Emily, submitted a hospitalisation and surgical claim.

The insurer declined the claim, asserting that cochlear implants are external devices similar to hearing aids and therefore fall under the policy exclusion.

Exclusions

The Supplementary Hospitalisation Contracts do not cover any Hospitalisations, Surgery or charges caused directly or indirectly, wholly or partly, by anyone (1) of the following occurrences:

Elective/Plastic/Cosmetic Surgery, circumcision (except circumcision due to infection), eye examination/elective surgery for visual impairments due to nearsightedness, farsightedness or astigmatism or radial keratotomy; all corrective glasses, contact lenses or intraocular lens (except monofocal intraocular lenses in cataract) surgery or the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids and prescriptions;

FINDINGS

Polly was diagnosed with bilateral sensorineural hearing loss in July 2020, with prior otitis media in 2018. She underwent cochlear implantation in September 2021. The cochlear implant is a surgically implanted neuroprosthetic device that bypasses damaged ear structures to stimulate the auditory nerve.

While it has an external processor, the core device is internal, surgically implanted, and permanent. The main costs arise from hospitalisation, surgery, anaesthesia, and the implanted component.

Cochlear implants differ significantly from external devices like hearing aids, which can be worn or removed without the need for surgery. A cochlear implant is partially inserted into the ear and requires surgery.

The policy’s exclusion mentioned external devices, but it does not clearly exclude surgically implanted devices. Applying noscitur a sociis (a legal principle meaning “a word is known by the company it keeps”), the examples listed in the exclusion, hearing aids, artificial limbs, are all non-surgical and entirely external. Therefore, any uncertainty should be resolved in favour of the policyholder.

KEPUTUSAN

After reviewing the matter, the insurer acknowledged the claim’s validity and agreed to cover the costs. Emily accepted the settlement, and the matter was resolved amicably.