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

Isuzu Australia Introduces Innovative Truck Leasing and Finance Services Isuzu Australia Introduces Innovative Truck Leasing and Finance Services
09 Mar 2026: Paige Estritori

Isuzu Australia has announced the establishment of Isuzu Financial Services Australia (IFSA), a pioneering truck leasing and finance company set to commence operations in the third quarter of next year. This initiative marks the first time the Isuzu Group has founded such a company outside Japan, highlighting the strategic importance of the Australian market. - read more
Inattention and Speed Identified as Primary Causes of Major Truck Crashes Inattention and Speed Identified as Primary Causes of Major Truck Crashes
09 Mar 2026: Paige Estritori

The National Truck Accident Research Centre (NTARC) has released its latest Major Incident Investigation Report, shedding light on the predominant causes of significant truck crashes across Australia. The findings reveal that human factors, particularly inattention, distraction, and inappropriate speed, continue to be the leading contributors to these incidents. - read more
New Legislation Prohibits Life Insurers from Using Genetic Test Results New Legislation Prohibits Life Insurers from Using Genetic Test Results
08 Mar 2026: Paige Estritori

The Australian government has enacted legislation prohibiting life insurers from using the results of genetic tests to refuse coverage or increase premiums. This landmark decision aims to eliminate genetic discrimination and encourage individuals to undergo potentially life-saving genetic testing without fear of financial repercussions. - read more
Australian Insurers Face Challenges in Cyber and AI Risk Readiness Australian Insurers Face Challenges in Cyber and AI Risk Readiness
08 Mar 2026: Paige Estritori

Recent findings from the PwC Insurance Banana Skins Survey have raised concerns about the preparedness of Australian insurers in managing emerging risks, particularly those associated with cyber threats and artificial intelligence (AI). The survey, which gathered insights from 698 insurance executives across 42 territories, including 37 from Australia, indicates that Australian insurers scored 6.6% lower on the Preparedness Index compared to their global counterparts. - read more


Life Insurance Articles

Unexpected Illness & Injury: Navigating Financial Security for Your Family Unexpected Illness & Injury: Navigating Financial Security for Your Family
Life is an unpredictable journey filled with twists and turns that can challenge even the most prepared among us. Sudden illnesses and unexpected injuries are just some of the uncertainties that can disrupt the harmony of family life. The emotional turmoil brought on by these circumstances is often compounded by the financial strain they can cause. It's during these trying times that the true value of peace of mind becomes clear. - read more
Top Mistakes to Avoid When Comparing Income Protection Insurance Top Mistakes to Avoid When Comparing Income Protection Insurance
Insurance plays a pivotal role in maintaining financial stability, especially for working adults in Australia. It acts as a safety net, offering peace of mind in the face of uncertainties. By securing an insurance policy, individuals protect themselves against potential financial disruptions caused by unexpected events. - read more
Income Protection Insurance Explained: Ensure Your Livelihood in Times of Uncertainty Income Protection Insurance Explained: Ensure Your Livelihood in Times of Uncertainty
When life takes an unexpected turn, whether due to illness, injury, or other unforeseen events, the financial repercussions can be devastating. This is where income protection insurance becomes an essential component of maintaining financial stability. Income protection insurance acts as a safety net, ensuring that even in times of hardship, your financial obligations can be met, and your standard of living maintained. It provides peace of mind, knowing that your earnings are safeguarded should you become unable to work due to health reasons. - read more
How Income Protection Insurance Can Safeguard Your Financial Future How Income Protection Insurance Can Safeguard Your Financial Future
Income protection insurance is a type of insurance policy designed to replace a portion of your income if you are unable to work due to illness or injury. This financial safety net can help cover essential living expenses, such as mortgage repayments, utility bills, and daily costs, ensuring you maintain your standard of living during tough times. - 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
Depreciation:
The reduction in the value of an asset over time, used in insurance to calculate the actual cash value of property.