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Husband loses insurance dispute over wife's death

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A man whose wife’s life insurance policy was revoked after a superannuation death benefit clause change has lost his dispute.

Legislation that started in March 2019 would have ceased the woman's default cover, unless she responded to a notice saying she wanted it to continue. The trustee said it complied with legislation by emailing the notice, but the complainant said she never received it.

The life insurance policy ceased on July 1 2019. On March 5 2020, the member asked for a replacement of the policy and was covered again. The member died on February 12 2021, and the complainant made a claim for the death benefit.

But AIA declined to pay, after determining that she had died from a preexisting medical condition. The complainant argued that he should be paid the death benefit but the trustee rejected the claim.

The complainant stated that it was never their intention to cancel the death benefit and in fact were relying on the benefit payout as part of her final estate for the family.

He went on to say that the trustee had failed to appropriately notify them that the death benefit would be cancelled.

He said that they had not been initially made aware that the death benefit had ceased. "When we did become aware, via online account, that the death benefit had ceased, we contacted [the trustee] to have it reinstated immediately.” he said.

He said the trustee also did not mention that the new cover excludes pre-existing conditions.

However, the Australian Financial Complaints Authority said it was satisfied and that new cover was explained in the Product Disclosure Statement. The decision to decline the claim is fair and reasonable, it added.

Published:Tuesday, 17th May 2022
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

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Subrogation:
The process by which an insurance company seeks to recover the amount paid to the policyholder from a third party responsible for the loss.

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