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.
Insurance premiums for group life policies with long-term benefits have surged between 15% to 25% on average in the first half of the year, according to a mid-year market update from Marsh Australia. While the steepest increases affected those with adverse claims experiences, short-term rates and premiums for permanent disabilities remained relatively steady. The sector has also become more selective, with insurers adopting stricter underwriting standards, particularly eschewing high-risk industries. - read more
The federal government's initiative to accelerate housing development by relaxing certain building regulations has raised alarm within the insurance sector. Housing Minister Clare O’Neil announced changes on social media, indicating a strategic pause on parts of the National Construction Code to expedite building approvals and encourage the construction of much-needed homes across Australia. This move comes in response to challenges in the approval process, which often delays construction. - read more
RACQ Insurance has been instructed to bolster a payout to a customer following a ruling by the Australian Financial Complaints Authority (AFCA). The dispute arose after the insurer's handling of a house fire claim lodged by a woman in October 2023 was found lacking. The fire, initiated by scented candles, resulted in significant fire and smoke damage to her home. - read more
The Australian Securities and Investments Commission (ASIC) has spotlighted significant shortcomings in the direct sale of life insurance products, urging the industry to reassess its sales practices. The recent review unearthed ongoing issues with remuneration structures, indicating that some insurers still link commissions to sales targets, potentially fostering aggressive sales tactics. The study further revealed a troubling rise in claims disputes, with reported cases more than doubling since 2018, raising concerns about the transparency and trustworthiness of these policies. - read more
A recent ruling by the Australian Financial Complaints Authority (AFCA) has upheld an insurer's decision to impose an additional $2000 excess on a property policy, following a dispute raised by a policyholder over claims history impacts. - read more
Explore Alternative Insurance Options
Discover trusted solutions from our family of brands:
Comprehensive Indemnity Insurance to Protect Your Professional Reputation
