Ella has been a client of Craig Matthews and Insurance House Life for nearly four 4 years. In April of this year she contacted Craig with a request to cancel her insurances as she was having financial difficulties and wasn't able to afford the premium. Ella had not worked for 3 years due to a work event that triggered depression, anxiety and stress. Craig suggested she make a claim under her income protection policy, Ella hadn't thought to consider this as she'd been receiving workers compensation.
The initial claim submitted by Craig was accepted by the insurer and entitled Ella to a monthly top up of her workers compensation up to her sum insured. This amounted to an additional payment of $2,500 a month and was an enormous help to Ella who was in financial difficulty.
Craig then started discussions with the insurer to get back payments approved, as most insurers will backdate the claim to the date of illness or injury.
The insurer denied the claim as they have a clause in their fine print that states that if the illness is more than 30 days old the date of the notification becomes the beginning of the waiting period.
"Your attention, professionalism and incredible support offered to us has been second to none. It has left both Ella and I
touched and incredibly grateful"
John - Spouse
Craig went searching for the clause under which the insurer were denying the claim. Noticing it was not included in the Policy Definitions section where you would typically expect but in a more obscure section he challenged it with the State Claims Manager.
Craig stated that the clause was deceptive as it was buried in fine print and also argued that it was against industry standards. Initial discussions with the State Claims Manager didn't go well and they upheld the denial.
Craig refused to accept this response and pressed on. He researched the market, comparing various income protection policies and found that the holding insurer was the only one on our approved panel that carried this clause.
With this information Craig went back to the insurer and made a formal complaint. Arguing that their policy had a sub-standard clause and had he know this he would have placed cover for his client elsewhere.
The complaint was referred to the insurers Board who upheld Craig's complaint and approved the claim.
Payment of $122,000 was made to Ella and the claim was settled.
During the time that it took for Craig to challenge the insurer and have his clients claim approved, Ella and her family were experiencing severe financial difficulty and at risk of losing their home.
The claim settlement helped secure their home and has made a real difference to their lives.
“You need to know that acts such as yours can and do change peoples lives and the world would be a much better place if it had more people like you in it.” - John
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General Advice Disclaimer:
Any advice in this publication is of a general nature only and has not been tailored to your personal circumstances. Please seek personal advice prior to acting on this information. Before making a decision to acquire a financial product, you should obtain and read the Product Disclosure Statement (PDS) relating to that product.
Tim Hawker, Craig Matthews and Nicky Hamilton-Morris of Investment House Echuca T/As Insurance House Life ABN 90 105 663 401, are authorised representatives of Apogee Financial Planning Limited ABN 28 056 426 932, an Australian Financial Services Licensee, Registered office at 105 –153 Miller St North Sydney NSW 2060 and a member of the National Australia group of companies.