Reasons For Rejection Of A Total Permanent Disability Insurance Payout

When you get afflicted by an incapacitating illness or injury, the last thing you ever want is a rejection of your Total Permanent Disability insurance payout. Therefore, you must ensure, earlier on, to avoid every possible condition that would lead to such a scenario. The most likely of which, has to do with non-disclosure.

Failure Of Disclosure

The Insurance Contracts Act, 1984 stipulates that failure to disclose or lack of truthfulness concerning relevant information on the part of policy holders is likely to affect claims made for benefit payments. In such an instance, the insurance company can decline to offer you any benefits. In fact, you may even be forced to repay any amount of money that you may have already received as a benefit payment.

To avoid such an unfortunate circumstance, you should always be completely truthful and openly state all relevant information at the time of application or renewal of your policy. You should also make sure to update all relevant details in the course of coverage, in case significant changes occur. This is especially the case when you move house, which would affect your contact address.

At times, policy holders may be interested in increasing their level of coverage. This would usually necessitate updating of their health information. In certain circumstances, you may not be required to provide such details. An example is the case of members of AustralianSuper who are eligible for automatic coverage. However, this exemption from providing health details would only apply up to a certain level of increased coverage.

Even when you lodge a claim for your benefit payment, the insurer may request for further information. This is necessary in order to fully assess your claim. Therefore, you should be willing to comply as much as possible in order to facilitate payment.

To be on the safe side, always make sure to thoroughly review the product disclosure statement concerning the insurance product you purchase. This will prevent contravention of full disclosure policies, which can also affect the type of coverage you're eligible to purchase.

What To Do If Your Payout Is Rejected

In certain circumstances, your claim may be denied by the insurance company. If you believe that you weren't treated fairly, you should request the underwriter to review such a decision. If such a review is still not satisfactory, you can address this matter through a series of 2 more steps:

(i) Appeal to the insurer's Complaints and Disputes Resolution Manager. This is based on the internal dispute resolution service of the insurance company, which is a requirement based on the standards set out by the Australian Securities and Investments Commission (ASIC).

Ensure that you submit a detailed complaint, which would be even better if it includes a comprehensive report from your doctor. You can be sure that your complaint will receive the seriousness it deserves, since the insurer is required to report all such complaints to the Australian Prudential Regulation Authority (APRA).

(ii) Finally, you can submit your complaint directly to the Financial Ombudsman Service (FOS). Remember that this final step can only be utilized only if you've gone through the initial two steps without getting a satisfactory response. However, you should realize that certain complaints may not be considered, of which you'll be informed by the FOS.

Kerrie Peacock has an in-depth understanding of the personal insurance industry. She regularly reviews the products available within the Australian market. MeCovered is among the best professional consultants within the personal insurance industry. Click to get more idea on personal cover.

This article was published on 20 Jul 2014 and has been viewed 543 times
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