AFCA has found in favour of a policyholder in a dispute over the duration of income protection payments.
The complainant, who has been receiving income protection benefits since January 2022, challenged Resolution Life Australasia’s decision to stop payments on 29 April 2025 – when the policy was to expire.
He claimed the policy entitled him to a 60-month benefit period, which would see him receive payments until January 2027.
AFCA found the insurer failed to conclusively establish when the benefit period was contractually due to end, as the original policy schedule – which was supposed to list the policy end date – was not produced.
The determination criticised the insurer’s reliance on assumed documentation…
In its assessment, AFCA noted the insurer had issued annual schedules from 2014 to 2024 stating a 60-month benefit period, even in years where fewer than 60 months remained before the supposed expiry date of the policy.
Even when the claim was made by the policyholder, the most recent schedule stated a 60-month benefit period, despite only 48 months remaining on the policy.
AFCA states: “The documents in this case show conclusively that for many years the insurer has not sent the complainant schedules which clearly showed, or even allowed him to work out, when his benefits would end according to the original terms of the policy. That is unfair.”
The determination criticised the insurer’s reliance on assumed documentation, historical policy templates, and examples from unrelated clients to substantiate its position.
Notably, AFCA dismissed the argument that the insurer’s transition through numerous entities – as a result of mergers and acquisitions since 1996 – absolved it of responsibility for missing documentation.
Resolution Life Australia has been ordered to continue paying benefits for up to 60 months from the claim date, provided the complainant continues to meet eligibility requirements.
AFCA notes its decision underscores the importance of maintaining full and accessible policy documentation – especially for legacy contracts.
