Compare Life Insurance :: News
SHARE

Share this news item!

AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case

AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case

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.

Published:Wednesday, 4th Sep 2024
Source: Paige Estritori

Share this news item:

Insurance News

WFI Insurance and Rural Aid Join Forces to Assist Farmers in Crisis WFI Insurance and Rural Aid Join Forces to Assist Farmers in Crisis
02 Feb 2026: Paige Estritori

In a significant move to bolster support for Australia's agricultural sector, WFI Insurance has announced a formal partnership with Rural Aid, a leading rural relief charity. This collaboration is set to provide much-needed assistance to farmers and rural communities affected by recent natural disasters, including the devastating bushfires in Victoria and severe weather events in Queensland. - read more
Elders Insurance Warns Farmers of Escalating Summer Storm Threats Elders Insurance Warns Farmers of Escalating Summer Storm Threats
02 Feb 2026: Paige Estritori

As the Australian summer approaches, Elders Insurance is calling on farmers to brace for an anticipated increase in storm-related damages. Recent claims data reveals a concerning trend, with summer months accounting for nearly half of all storm-related farm insurance property claims over the past two years. - read more
AFCA Observes Significant Increase in General Insurance Complaints AFCA Observes Significant Increase in General Insurance Complaints
01 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has reported a 17% increase in general insurance complaints for the year ending June 30, 2025, totalling 34,231 cases. This uptick is primarily attributed to issues surrounding add-on covers and delays in motor vehicle insurance claims. - read more
APRA's Findings: Stability in PI Claims and Decreasing Premiums APRA's Findings: Stability in PI Claims and Decreasing Premiums
01 Feb 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) has released its latest National Claims and Policies Database, providing valuable insights into the professional indemnity (PI) insurance sector for the 2022 underwriting year. The data indicates that PI claims payments for non-facility business remained relatively stable at $1.111 billion, a slight increase from $1.109 billion in the previous year. - read more


Life Insurance Articles

How Much Life Insurance Does Your Family Actually Need? How Much Life Insurance Does Your Family Actually Need?
Financial security for families is an essential consideration in any household. Life can be unpredictable, and ensuring that your loved ones are protected from financial hardship in your absence is a critical part of financial planning. - read more
Understanding Life Insurance: Coverage Types to Protect Your Loved Ones Understanding Life Insurance: Coverage Types to Protect Your Loved Ones
The importance of life insurance in financial planning: Life insurance isn’t just a policy; it’s a cornerstone of comprehensive financial planning. By protecting your family’s financial future, life insurance offers peace of mind, knowing that your loved ones will be taken care of in the event of your untimely passing. It’s not solely about leaving behind a legacy, but also ensuring that your family can maintain their standard of living, pay off debts, and cover end-of-life expenses without financial burden. - read more
A Comprehensive Guide to Income Protection Insurance in Australia A Comprehensive Guide to Income Protection Insurance in Australia
Income protection insurance is a type of insurance policy that provides financial support if you're unable to work due to illness or injury. It offers a replacement income, usually up to 75% of your normal wage, helping you maintain some level of income during tough times. - read more
How to Prepare Financially for Unexpected Sickness How to Prepare Financially for Unexpected Sickness
Life is full of surprises, and unfortunately, not all of them are pleasant. Unexpected sickness can strike anyone at any time, and when it does, it can have a significant impact on your income. Whether it’s a sudden illness, a chronic condition, or an accident, the loss of income can add stress to an already difficult situation. - read more


Start Here !
life insurance
Apply now for your free Insurance assessment and price comparisons!

Start Here

Life Cover Amount:
Postcode:


All quotes are provided free and without obligation. We respect your privacy.
Knowledgebase
Disability Insurance:
A type of insurance protection that pays a portion of a person's income lost due to a total or partial disablement arising from either an accident or a sickness.