We are a proud member of the Financial Services Online network!
Connect with us on your favourite social media platform for the latest financial news, views, tips, tricks, resources and information.
The woman was diagnosed with cancer in her right breast on October 5 of last year, followed by the discovery of cancer in her left breast eight days later. She filed claims under her critical illness policy that she had obtained on July 17.
However, TAL Life, her insurance provider, rejected the claims based on the policy's three-month qualifying period for cancer coverage.
In its ruling, AFCA noted that the policy had provisions to potentially waive the qualifying period if the policyholder could prove they were insured either under a previous TAL policy or by another insurer for the same events, right before their new coverage commenced.
The claimant contended that she had cancer coverage through an insurance policy provided by her husband's employer. She presented a letter from the employer affirming that she was covered under a "life, accident, critical illness, and medical insurance" scheme from August 2020 until June last year. Additionally, she showed documentation indicating her husband’s policy did include critical illness coverage for spouses, encompassing cancer.
While AFCA accepted the availability of this cancer coverage, it was not convinced that she held such coverage "immediately before the current policy began." It also noted she had failed to disclose her previous insurance when applying for the new policy with TAL Life.
"There is no information before me about the extent of the critical illness cover the complainant had, if any, through her husband's employer’s insurance arrangements," AFCA’s ombudsman stated.
"Furthermore, it appears that any cover she might have had ceased about a month before the new policy started. I am not convinced there was 'continuity of cover' as suggested by the complainant."
The ombudsman expressed AFCA’s sympathy towards the claimant, especially given that the diagnoses occurred "very close to the end of the qualifying period." Nonetheless, he emphasized that there was no valid reason for the qualifying period to be dismissed.
"The qualifying period is reasonably short and its existence is not unjust. These terms are part of all insurance policies and they draw necessary boundaries. The enforcement of these terms is not inherently unfair," the ombudsman elaborated.
For a more detailed account of the ruling, refer to the original report by AFCA.
Published:Wednesday, 4th Sep 2024
Source: Paige Estritori
| Stolen Bag Saga: Travel Insurance Dispute Highlights Policy Loopholes 07 Oct 2024: Paige Estritori A recent travel mishap has brought attention to travel insurance policy nuances, as a traveler successfully claimed $6,300 after his bag was taken by a tuk-tuk driver during an overseas trip. - read more |
| Calls for Transparency Surge as Disclosure Debate Continues 04 Oct 2024: Paige Estritori In the evolving landscape of insurance broking, the push for greater transparency surrounding broker remuneration has gained renewed momentum. Amidst ongoing assessments of the Insurance Brokers Code, the Code Compliance Committee has vocally advocated for a reinstatement of mandatory remuneration disclosures to small business clients, with a strategic focus on refreshing trust through clarity. - read more |
| icare Ushers in Major Changes Starting Next Week 01 Oct 2024: Paige Estritori Commencing on October 8, icare is gearing up for significant structural changes aimed at streamlining operations and boosting efficiency. This initiative comes in response to a comprehensive Operational Expenditure Review conducted by NSW Treasury, which outlines 14 pivotal findings to help reduce the state's insurer's service costs by 5%. - read more |
