The Australian Financial Complaints Authority (AFCA) has upheld PetSure's decision to cap their payout at $2,600 for a dog's medical costs, settling a dispute over pet insurance claims.
The dog's accidental injury involved a ruptured cranial cruciate ligament, requiring approximately $6,500 in veterinary care, including surgery.
Although the owners' claim was initially accepted, it was limited under the policy's annual sublimit for cruciate ligament conditions.
The owners contested that the claim should be categorised under a different accidental injury cover. However, PetSure maintained that their policy clearly states that the sublimit for ligament injuries includes those sustained accidentally. Despite arguments that the policy language did not explicitly mention cruciate ligament injuries, AFCA ruled that the policy's intention was unambiguous.
AFCA clarified in their ruling that a cruciate ligament condition encompasses injuries caused accidentally, such as during jumping. They emphasised that the policy is intended to cover such traumatic injuries under the designated cruciate ligament condition.
This ruling provides clarity for consumers regarding how pet insurance policies categorise ligament injuries and their associated sublimits. It reinforces the importance of understanding policy definitions and limits, especially concerning common but costly pet injuries. The decision highlights that insurers' policy wordings can significantly impact the financial outcomes of policyholders.
Moving forward, pet owners may need to pay closer attention to policy details, specific limitations, and definitions to avoid similar disputes. For insurers, this ruling could lead to clearer policy communications and documentation. Moreover, pet owners might seek more comprehensive coverage or additional clarification from insurers on what constitutes accidental injury versus pre-defined conditions to ensure adequate financial protection for potential injuries.
Starting on October 1, a comprehensive review of the voluntary Life Insurance Code of Practice will commence, with a focus on assessing the effectiveness of revisions made to its regulations and standards in 2023. The Council of Australian Life Insurers (CALI) has appointed Peter Kell to lead this independent review and deliver the final report by June 30 next year. - read more
The Australian Financial Complaints Authority (AFCA) has upheld PetSure's decision to cap their payout at $2,600 for a dog's medical costs, settling a dispute over pet insurance claims. The dog's accidental injury involved a ruptured cranial cruciate ligament, requiring approximately $6,500 in veterinary care, including surgery. Although the owners' claim was initially accepted, it was limited under the policy's annual sublimit for cruciate ligament conditions. - read more
Australia's retail life insurance sector is facing significant challenges despite generating approximately $9.4 billion in annual premiums. Upon closer examination, it's evident that this industry is under strain. Growth is primarily driven by price increases rather than the addition of new clients, signalling concerns for long-term sustainability. New business growth hovers around 8-9% annually, not enough to adequately bolster the sector. - read more
The New South Wales government has issued a stark warning regarding potential financial consequences if proposed reforms to workplace mental injury laws are delayed further. As an upper house committee gathers to discuss these changes, Treasurer Daniel Mookhey highlights the urgency, stating that setbacks will result in increased premiums. - read more
An Australian travel insurance policyholder faced disappointment as the Australian Financial Complaints Authority (AFCA) denied their claim for reimbursement of costs incurred due to changing travel plans amid threats of a pilot strike. The traveller, who rearranged his flights from Sydney to Vancouver and subsequently to Toronto, had hoped his insurer, AIG Australia, would cover the $5,576 expenses for the rebooked flights and additional accommodation. - read more
Travel insurance is an indispensable component for any savvy traveller from Australia, playing a protective role in a myriad of situations that may occur away from home. Whether it's encountering flight delays, requiring medical assistance, or facing luggage theft, having a solid travel insurance policy can convert potential nightmares into manageable inconveniences. Yet, despite its importance, the process of finding a policy that won't break the bank is increasingly challenging. - read more
Traveling overseas is an exciting experience yet can be challenging, especially for Australians on a budget. With careful planning and budgeting, it is possible to make the most out of your trip without breaking the bank. This article provides valuable money-saving tips for Australians looking to explore the world on a restricted budget. - 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
Travel insurance is a crucial aspect of planning a trip, especially for Australian travelers who venture far and wide. With the vast array of destinations Australians frequent, from exploring the natural wonders of the Outback to adventuring abroad, having a safety net in place can provide peace of mind. - read more
Picture this: You're all set for your dream vacation. Suitcases packed, tickets in hand, and the excitement building. But then, an unexpected disappointment hits. Your flight is cancelled. Suddenly, your well-laid plans are thrown into disarray. - read more
Knowledgebase
Double Indemnity: A clause or provision in a life insurance policy that doubles the payout in cases of accidental death.
