Indemnity insurance may sound like complex legalese, but at its core, it's a straightforward and crucial protection for businesses of all types and sizes. Simply put, it's a form of insurance that shields a business from bearing the full brunt of financial losses due to lawsuits or claims made against it. - read more
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Professional Indemnity Insurance (PII) remains one of the keystones of risk management for professionals across Australia. Yet, misconceptions and lack of awareness can lead to inadequate coverage, leaving individuals and businesses vulnerable in a litigious environment. - read more
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Embarking on the entrepreneurial journey of running a small business comes with not only the thrill of potential success but also the specter of various risks. One of the most effective shields against the unforeseeable is small business insurance—a critical tool that safeguards your enterprise's financial health. In this section, we'll demystify the role insurance plays in protecting your small business and provide a brisk walkthrough of the different types of insurance options available. - read more
Indemnity insurance may sound like complex legalese, but at its core, it's a straightforward and crucial protection for businesses of all types and sizes. Simply put, it's a form of insurance that shields a business from bearing the full brunt of financial losses due to lawsuits or claims made against it. - read more
In an era dominated by digital innovation, understanding the crossroads of cybersecurity and indemnity insurance is more critical than ever for IT professionals. As cyber threats evolve with increasing sophistication, the concept of cyber liability has come into sharp focus, pinpointing the potential legal and financial risks associated with data breaches and cyber-attacks that professionals in the information technology sector may face. - read more
AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case
AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case
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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.
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