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.
In a case brought to attention, the claimant, who secured his coverage via superannuation, applied for a $9300 monthly policy intended for a two-year coverage span back in March 2020.
The claimant's struggle began in August 2019 when his general practitioner declared him medically unfit for work due to "significant psychological distress," primarily catalyzed by workplace bullying.
As a recourse, the individual took personal leave in August followed by paternity leave in October of the same year. Although he resumed work in October 2020, he had to suspend his professional engagements again by December.
In September 2021, the claimant submitted a request for income protection benefits, citing an adjustment disorder diagnosed with mixed anxiety and depression as the reason inhibiting his capacity to work.
However, MetLife rejected the claim in July 2022, accusing the claimant of inaccurately representing his medical history. The insurance provider argued that the applicant falsely stated he hadn’t been “diagnosed with or sought medical advice or treatment” for psychological issues at the time of application.
MetLife asserted that the applicant already exhibited psychological distress, hindering his work capability long-term, and had they known, the policy would not have been issued. They determined his stress related symptoms equated “to a psychological condition.”
The claimant countered, maintaining he neither identified with a history of psychological ailments during his application process, nor would a typical person in his context.
AFCA elaborated, saying although the complainant experienced "significant stress in 2019," ordinary perception does not always align stress with a psychological or clinical mental health condition. The inquiry focused on awareness of any conditions at the time, not diagnosis existence.
AFCA highlighted that the treating GP did not insist on mental health assessments commonly expected when symptoms emerge, and the sole "treatment" employed was voluntarily steering clear of the work environment, a decision lacking a formal diagnosis.
They elucidated that “Even if the answers given were not actually true (because with the benefit of hindsight the complainant was in fact suffering from a psychological or mental health condition), the panel accepted a reasonable person in the circumstances would also have reached the same belief as the complainant did.”
Following the conclusion, AFCA mandates MetLife to process and revisit the claimant’s submission and communicate the outcome to Hostplus, the coverage trustee, within a 60-day frame. The original content was reported by the Australian Financial Review.
Published:Friday, 1st Nov 2024
Source: Paige Estritori
| Soaring Insurance Premiums Amid Changing Climate 14 Nov 2024: Paige Estritori As climate change persists, the impact of severe weather on insurance premiums is becoming more evident, pushing affordability out of reach for many Australians. Bernadette Systa, a mother of five, faced an undeniable financial strain as her annual home and contents insurance costs surged from a modest amount to more than twice what she initially paid. This experience echoes a growing dilemma faced by households across the country. - read more |
| Insurers Eye AI for a Technological Future 12 Nov 2024: Paige Estritori The insurance sector is gearing up for a significant technological transformation with plans to integrate artificial intelligence (AI) extensively in the coming years. A survey conducted by Earnix highlights that over two-thirds of insurance companies are planning to deploy AI tools within the next two years. This trend marks a pivotal moment in the industry's journey toward modernization. - read more |
| APRA Explores Alternative Reinsurance Solutions Amid Market Challenges 11 Nov 2024: Paige Estritori The Australian Prudential Regulation Authority (APRA) is reshaping its approach to the reinsurance sector, focusing on enhancing premium affordability and availability for insurers. In an effort to modernize the reinsurance framework, APRA seeks comprehensive feedback from relevant stakeholders. - read more |
| Insurance Landscape: Future Trends and Insights 11 Nov 2024: Paige Estritori In its latest release, designed to enhance industry understanding, CGU has unveiled the third installment in its Strive guide series. This edition provides valuable insights for brokers, highlighting current trends and significant shifts impacting the insurance sector and the broader economic environment. - read more |
| Insurance Dilemma: Ignored Occupation Costs Claimant His Compensation 08 Nov 2024: Paige Estritori A recent case involving an Uber Eats driver has highlighted the critical importance of truthfulness when disclosing occupational details to auto insurers. The claimant's car crash claim was rejected due to an undisclosed delivery job, marking a significant case study on the enactment of insurance policy terms. - read more |
| How to Compare Life Insurance Policies in Australia Without Overpaying Life insurance stands as a pillar of financial stability in the lives of many Australians, providing peace of mind and security for families and individuals facing the uncertainty of the future. The importance of life insurance cannot be overstated; it offers a safety net that serves to protect your loved ones in the event of a tragedy, ensuring their financial well-being during difficult times. - read more
|
| How to Choose the Right Boat for Your Needs and Budget Choosing the right boat can be a daunting task, particularly if you’re new to boating or unfamiliar with the full range of options available. With so many different types, sizes, and features to consider, it’s important to have a clear understanding of your needs and preferences before you start shopping for a boat. - read more
|
| Starting Out: How to Pick the Right Insurance As a Young Professional in Australia Welcome to the journey of safeguarding your future! As a young professional in Australia, you're likely juggling the demands of a burgeoning career with personal goals and financial responsibilities. Navigating the world of insurance is critical in creating a safety net around these aspirations. But why exactly is insurance a cornerstone for those entering the professional realm, and how do you discern which coverage best aligns with your unique pathway? - read more
|
| Unlocking the Best Business Insurance: A Guide for Aussie Entrepreneurs Welcome to the guide designed to navigate Australian entrepreneurs through the intricate world of business insurance. In an era where risks are as diverse as they are frequent, choosing the right insurance is not just prudent—it's a critical element of sustaining and growing your enterprise. - read more
|
| The Differences Between Public Liability and Professional Indemnity Insurance In the dynamic world of commerce, Australian businesses face a plethora of risks daily. Business insurance serves as a safeguard, ensuring that the unforeseen does not hinder the stability and growth of an enterprise. Whether it’s a startup or a seasoned corporation, understanding and selecting the appropriate insurance coverage is crucial for resilience and longevity. - read more
|
|
Business Insurance in Australia: How to Ensure You're Fully Covered Embarking on the journey of entrepreneurship entails foreseeing and mitigating risks before they turn into setbacks for your business. In Australia, safeguarding your enterprise with adequate business insurance is not just a regulatory requirement, but also a strategic move to protect your company's future. In this article, we delve into the importance of being fully covered and guide you through the myriad of insurance options suitable for your business venture. - read more
|
|
Family Planning: Exploring Life Insurance Options for New Parents Stepping into parenthood comes with a myriad of responsibilities, one of which includes securing your family's financial future. Life insurance serves as a financial cornerstone for young professionals who are navigating the complexities of family planning. Recognizing the significance of the role insurance plays can empower new parents to make informed decisions that corroborate their family's safety and well-being. - read more
|
|
Navigating Business Interruption Insurance: A Lifeline for SMEs Understanding the safeguards available to protect businesses during times of unexpected adversity is crucial, especially for Small and Medium-sized Enterprises (SMEs). Chief among these safeguards is business interruption insurance. This form of coverage is designed to offer financial assistance to businesses that endure losses due to unforeseeable disruptions. - read more
|
|
Protecting Your Legacy: Estate Planning and Life Insurance for Australians When thinking about the future, it's essential to have a comprehensive strategy that ensures the well-being of your loved ones and the security of your assets. Estate planning and life insurance are two critical pillars in safeguarding your family's financial stability. Despite the complexity often associated with these topics, understanding their importance and implementing them correctly can provide immense peace of mind. - read more
|
|
|
The Differences Between Public Liability and Professional Indemnity Insurance In the dynamic world of commerce, Australian businesses face a plethora of risks daily. Business insurance serves as a safeguard, ensuring that the unforeseen does not hinder the stability and growth of an enterprise. Whether it’s a startup or a seasoned corporation, understanding and selecting the appropriate insurance coverage is crucial for resilience and longevity. - read more
|