A policy exclusion for pituitary gland tumours does not apply to a man who had brain surgery, the financial services ombudsman has ruled.

The man claimed on trauma cover within his income protection policy after the operation last year to remove a benign tumour that extended from the pituitary gland.

Zurich denied the claim, citing its exclusion, but the man argued the policy covered benign tumours of the brain, and his tumour extended from his pituitary gland into his brain.

He also said that after the operation he developed central diabetes insipidus (DI). He submitted a report from an endocrinologist who described this as a neurological condition that has a substantial impact on daily functioning and wellbeing.

Zurich’s medical officer said DI is a hormonal deficit, not a neurological deficit.

Two more medical officers reviewed the case and agreed the tumour fell within the policy exclusion.

Zurich also said there was no evidence the pituitary tumour had produced a neurological deficit resulting in the man being unable to perform at least one activity of daily living.

But in ruling the claim should be accepted, an Australian Financial Complaints Authority ombudsman says there is no dispute the pituitary tumour extended into the brain.

And two doctors described DI as a permanent neurological condition that resulted from neurological impairment.

“I am satisfied that the complainant has suffered a significant impairment of an important bodily process and that is permanent,” the ombudsman said.

While the wording of the “tumours in the pituitary gland” exclusion is clear, if the insurer wanted to exclude those that extended from the gland, it could have drafted the exclusion in a different way.

The man’s treating specialists were well qualified to opine, while the insurer medical officers’ expertise was unknown, the ombudsman adds.

Read the determination here.