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Tag Archives | definitions

Insurance How To – Trauma Insurance

This Insurance How To goes back to basics and explains the purpose of trauma cover and how to calculate an appropriate sum insured for your clients… At a glance Provided by: BT Financial Group Topics covered: trauma cover, calculating sum insured In detail Trauma insurance generates a range of views in the financial advice community. […]

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Case Study – Unsuccessful Job Applications and their Impact on TPD

In the case of Birdsall v Motor Trades Association of Australia Superannuation Fund Pty Ltd and MetLife Insurance Limited, the Supreme Court of New South Wales delivered a judgment which considered, among other things, whether an insured’s unsuccessful job applications demonstrated Total and Permanent Disablement (TPD) under a group life insurance policy. TurksLegal Senior Associate, […]

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Case Study – Ward v MetLife

In this legal case, the plaintiff sued his insurer after his group salary continuance claim was discontinued because he was deemed to be no longer disabled. The case highlights the difficulties insurers and the courts can experience when dealing with mental health claims. At a Glance Source: Judges’ decision notes, with commentary by Terry Ward, claimant Topics covered: mental […]

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Case Study – FOS Determination – Income Protection Offset

This case looks at a dispute between a claimant and their insurer, which was resolved by the Financial Ombudsman Service in June 2014. The insurer applied an offset clause to the claimant’s income protection benefit, reducing the payments. FOS overruled the insurer, ordering them to pay compensation. The case has implications for advisers recommending key […]

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Case Study – Preston v AIA Australia

In this legal case, a carpenter who took out a life insurance policy with AIA Australia, took the insurer to court for refusing to pay his TPD claim. The original judgement found in favour of the insurer, because the insured’s injury did not meet the policy definition of ‘accidental injury’. This decision was upheld by […]

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Case Study – Smoking Status

In this claims case study, the adviser shares the difficulties he encountered when lodging a claim for a client who had quit smoking prior to taking out his policy. The case study emphasises the importance of disclosure and definitions, and more significantly, the vital role a proactive and passionate adviser plays from contract to claim. At […]

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Case Study – Any Occupation TPD

In this claims case study, the adviser tells how she stepped in to help the client receive the TPD benefit they were entitled to through an industry super fund. It highlights the complexity of claims for group insurance inside superannuation, particularly when looking at the ‘any’ versus ‘own’ occupation definition. At a glance Provided by: […]

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