Woman loses suit against Prudential for brain surgery payout as judge rejects 'buried clause' argument

SINGAPORE: A woman has lost her suit seeking over S$108,000 (US$78,345) for brain aneurysm surgery from insurer Prudential Assurance Company Singapore, with the judge saying it is unfair to say Prudential had hidden a clause.Ms Cai Yunhong, 45, had alleged that Prudential had denied her claim because of a "single, buried clause" defining 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.However, in a written judgment on Thursday (Sep 3), a district court dismissed her claim, saying that the characterisation of the clause being hidden or buried in the policy document was "not a fair one".District Judge Teo Guan Kee said that on an objective view of the policy, there was no room for doubt about the coverage afforded and how coverage would not be engaged if an insured person underwent endovascular repair or procedures, as Ms Cai did.WHAT HAPPENEDMs Cai had suffered a stroke from a ruptured aneurysm in 2023 and collapsed while taking a bus. She was taken to hospital, with an emergency operation being performed by the head of neurosurgery at the National University Hospital.She spent 21 days in hospital, including eight days in the intensive care unit but recovered "miraculously well".Ms Cai claimed that she was not given a choice as to what type of surgery would be performed, and discovered only later that Prudential's policy made payouts only in instances where a brain aneurysm is treated via a surgical craniotomy – a procedure where part of the skull is removed to reach the brain.She had undergone endovascular repair instead, which she said was the modern, minimally invasive and evidence-based first-line treatment for her condition.Ms Cai had purchased a Prudential life insurance policy, the PruLife Multiplier Policy, through a sales channel operated by Standard Chartered Bank.The policy provided a few classes of coverage, including the Early Crisis Cover Multiplier, a supplementary benefit.She sought the full claim amount of S$108,500 under the early crisis cover multiplier, with accruing interest, as well as a refund of two years' premiums paid in 2023 and 2024 and a waiver of the remaining premiums under the policy. The latter sums come up to about S$12,000.At trial, Prudential denied that Ms Cai was entitled to any payout under the terms of the policy as brain aneurysm surgery was defined in the policy document as the "actual undergoing of surgical craniotomy" to repair certain conditions.It expressly states that endovascular repair or procedures are not covered.Prudential denied that it had failed to disclose relevant contractual clauses to Ms Cai, stating that she had purchased it through Standard Chartered and that the terms had been explained to her.Judge Teo said the policy had to be read as a whole and agreed with Prudential's interpretation that no payout was due.He said Ms Cai's subjective expectations of what the Early Crisis Cover Multiplier would or would not cover could not drive the court's interpretation of the policy.In any case, Ms Cai had a period of 14 days after receiving the policy to review its terms and conditions and to ask for it to be cancelled.Judge Teo stressed that he was making no findings on any duty or liability owed to Ms Cai by anyone not in the suit, including Standard Chartered or its employees.Prudential was represented by a team of lawyers led by Mr Joavan Pereira from Virtus Law.It previously told CNA 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.Ms Cai told CNA on Thursday that she would likely appeal the verdict.She had previously said that she filed the suit in hopes that no one will have to do the same, adding that her efforts will not be in vain if her case can shine a light on "these unfair practices", "force insurers to be transparent about their exclusions" and "remind them that they have a duty of good faith that must be honoured".Costs for the court case are yet to be fixed.