AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case
AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case
The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.
A recent ruling by the Australian Financial Complaints Authority (AFCA) has affected a woman’s critical illness claims, as her diagnosis came within mere days of her policy's eligibility period drawing to an end.
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.
Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.
Renewed attention on airline and airport industrial action overseas is a timely reminder for Australian travellers to look closely at how their travel insurance responds when transport plans unravel. Strikes can affect flights, baggage handling, airport security, public transport connections and tour schedules, turning a carefully planned itinerary into a costly scramble for new accommodation, meals and replacement bookings. - read more
Recent consumer reporting has again highlighted a familiar travel risk: some Australians are looking for savings by travelling without insurance, or by choosing the cheapest cover without checking whether it suits the trip. With airfares, accommodation and day-to-day holiday costs still stretching household budgets, it is understandable that travellers are scrutinising every expense. The problem is that travel insurance is often treated as optional until something goes wrong. - read more
Recent consumer attention on scooter and moped accidents overseas has highlighted a travel risk many Australians underestimate until something goes wrong. Hiring a scooter in Bali, Thailand, Vietnam or parts of Europe can feel like a simple holiday convenience, but insurers may treat it very differently from catching a taxi or joining a tour. - read more
Fresh consumer attention on travel to the United States has again highlighted one of the clearest reasons Australians buy travel insurance: overseas medical costs can be severe, and the US is a destination where even a short hospital visit may become financially stressful. For travellers planning holidays, business trips, cruises that call at US ports, or family visits, the issue is less about whether to buy cover and more about whether the policy is strong enough for the trip. - read more
Recent consumer attention on complimentary credit card travel insurance is a timely reminder that 'included' does not always mean automatic, comprehensive or suitable for every trip. For many Australians, card-linked cover can be a useful benefit, particularly where it is backed by a reputable insurer and activated correctly. The risk is assuming it works like a standalone policy without checking the fine print. - read more
Travel can be an exciting adventure, but it often comes with a myriad of expenses that can quickly add up. From flights and accommodations to meals and entertainment, the costs can take a toll on your budget. - read more
Welcome to a journey of discovery where the vibrant cultures, stunning landscapes, and rich history of Southeast Asia await. Australian travellers have long been captivated by the allure of our northern neighbours, seeking adventures that not only promise unforgettable experiences but also offer remarkable value for money. - read more
When it comes to travelling abroad, there's more to preparation than just packing the right clothes and booking your flights. For Australian travellers venturing overseas, assembling a financial travel kit is just as vital as a passport. This kit serves as your safeguard, ensuring that even when faced with the unpredictable, your journey remains as smooth as possible. - read more
Travel insurance is an essential component of any overseas trip, especially for Australians. While exploring new destinations and experiencing different cultures can be exciting, it's crucial to be aware of the potential risks and challenges that can arise along the way. From unexpected medical emergencies to lost luggage or trip cancellations, unforeseen events can quickly turn your dream holiday into a nightmare. - read more
Travelling is one of life's greatest joys, but it's not without its risks. This is where travel insurance comes into play for Australians. It ensures peace of mind, knowing that you're covered for unforeseen events such as medical emergencies, trip cancellations, or lost luggage. - read more
Knowledgebase
Insurance Deductible: That part of an insurance claim that must be paid by an insured person before the the balance is paid by the insurer.
No comments yet. Be the first to share your thoughts.