The crux of the dispute arose when the salon's laser machine broke down in February, and repair costs were estimated at $18,069. The salon owner had insured the machine for $50,000 in December of the previous year, following its second-hand purchase and refurbishment in 2012 for $66,000.
Despite acknowledging the damage, QBE Insurance reduced its compensation to $7,286, citing an underinsurance clause. QBE claimed that due to the model being discontinued, a replacement would necessitate insuring at $155,000.
The insurer's clause stipulated that if the sum insured was less than 80% of the "total new replacement value," the liability could be adjusted accordingly. However, the salon owner challenged this assessment, arguing that a comparable refurbished machine was valued between $30,000 and $45,000.
The Australian Financial Complaints Authority (AFCA) intervened, siding with the salon owner. AFCA declared that policy wording began ambiguous, noting discrepancies in terms such as "full value" and "total new replacement value", creating confusion about the clause's intent.
AFCA clarified: "When the policy is read as a whole, it indicates the laser should be insured for its full value, or what it would cost to replace with a similar laser in a similar condition." They refuted QBE's expectation that the salon owner should have insured the laser for $155,000, indicating she would never recoup more than $50,000 under policy terms.
This ruling mandates QBE to cover the repair costs, less the policy’s deductible. The case emphasizes the importance of clarity in insurance contracts and equitable treatment of claims.
Published:Wednesday, 27th Nov 2024
Source: Paige Estritori
| Significant Increase in Health Insurance Premiums Anticipated for 2026 21 Jan 2026: Paige Estritori Health insurance premiums are set to experience a substantial increase in 2026, with projections indicating a global rise of 10.3%. This marks the third consecutive year of significant hikes, following increases of 10% in 2025 and 9.5% in 2024. These figures are highlighted in WTW's 2026 Global Medical Trends report, underscoring the persistent inflationary pressures affecting insurers and employer-sponsored health plans worldwide. - read more |
| Private Health Insurers Under Scrutiny for Profits Amid Rising Premiums 21 Jan 2026: Paige Estritori Recent analyses have brought to light significant concerns regarding the profit margins of private health insurers in Australia, especially in the context of rising premiums. The Australia Institute has highlighted that major insurers are reporting substantial profits while simultaneously increasing premiums, a situation that has sparked criticism and calls for greater transparency within the industry. - read more |
| Health Minister Puts Private Health Insurers on Notice Over Pricing Practices 21 Jan 2026: Paige Estritori Health Minister Mark Butler has issued a stern warning to private health insurers in Australia, cautioning them against employing underhanded tactics to increase premiums. This comes in response to findings from the Commonwealth Ombudsman, which revealed that some insurers have been closing old policies and introducing more expensive new ones, effectively circumventing regulatory limits on premium hikes. - read more |
| AUSactive Unveils Comprehensive Insurance Solution for Fitness Professionals 21 Jan 2026: Paige Estritori AUSactive, Australia's leading body for the exercise and active health sector, has announced the launch of a new insurance product tailored specifically for fitness professionals. This initiative, developed in collaboration with global insurance broker Marsh, aims to provide enhanced protection while offering lower premiums compared to existing market options. - read more |
| Common Pitfalls in Income Insurance Claims and How to Avoid Them Income insurance is a critical component of financial planning, offering a safety net when life's uncertainties impact your income stream. It ensures that you can continue meeting your financial obligations even if you're unable to work due to illness or injury. This peace of mind is invaluable, especially in an unpredictable job market. - read more
|
| Protecting Your Loved Ones: The Role of Life Insurance in Estate Planning Estate planning is a process that involves the management and distribution of an individual's assets and responsibilities in the event of their passing or incapacitation. It is an essential part of financial planning that ensures your assets are managed according to your desires and your loved ones are taken care of. - read more
|
| The Comprehensive Comparison: Evaluating Different Insurance Providers in Australia Welcome to the comprehensive guide on evaluating different insurance providers in Australia. Navigating through the plethora of insurance options can be overwhelming. With a market full of competing insurers, choosing the right provider is critical to ensuring ample protection for your assets, health, and peace of mind. This introduction aims to underscore the significance of this decision for Australian consumers. - read more
|
| How to Choose the Right Income Protection Insurance as a Freelancer Income protection insurance is a type of coverage designed to replace a portion of your income if you're unable to work due to illness or injury. It's an incredibly vital form of insurance for freelancers, who may not have the same safety nets as traditional employees, such as paid sick leave or disability benefits. - read more
|