The Australian Financial Complaints Authority (AFCA) has upheld PetSure's decision to cap their payout at $2,600 for a dog's medical costs, settling a dispute over pet insurance claims.
The dog's accidental injury involved a ruptured cranial cruciate ligament, requiring approximately $6,500 in veterinary care, including surgery.
Although the owners' claim was initially accepted, it was limited under the policy's annual sublimit for cruciate ligament conditions.
The owners contested that the claim should be categorised under a different accidental injury cover. However, PetSure maintained that their policy clearly states that the sublimit for ligament injuries includes those sustained accidentally. Despite arguments that the policy language did not explicitly mention cruciate ligament injuries, AFCA ruled that the policy's intention was unambiguous.
AFCA clarified in their ruling that a cruciate ligament condition encompasses injuries caused accidentally, such as during jumping. They emphasised that the policy is intended to cover such traumatic injuries under the designated cruciate ligament condition.
This ruling provides clarity for consumers regarding how pet insurance policies categorise ligament injuries and their associated sublimits. It reinforces the importance of understanding policy definitions and limits, especially concerning common but costly pet injuries. The decision highlights that insurers' policy wordings can significantly impact the financial outcomes of policyholders.
Moving forward, pet owners may need to pay closer attention to policy details, specific limitations, and definitions to avoid similar disputes. For insurers, this ruling could lead to clearer policy communications and documentation. Moreover, pet owners might seek more comprehensive coverage or additional clarification from insurers on what constitutes accidental injury versus pre-defined conditions to ensure adequate financial protection for potential injuries.
Starting on October 1, a comprehensive review of the voluntary Life Insurance Code of Practice will commence, with a focus on assessing the effectiveness of revisions made to its regulations and standards in 2023. The Council of Australian Life Insurers (CALI) has appointed Peter Kell to lead this independent review and deliver the final report by June 30 next year. - read more
The Australian Financial Complaints Authority (AFCA) has upheld PetSure's decision to cap their payout at $2,600 for a dog's medical costs, settling a dispute over pet insurance claims. The dog's accidental injury involved a ruptured cranial cruciate ligament, requiring approximately $6,500 in veterinary care, including surgery. Although the owners' claim was initially accepted, it was limited under the policy's annual sublimit for cruciate ligament conditions. - read more
Australia's retail life insurance sector is facing significant challenges despite generating approximately $9.4 billion in annual premiums. Upon closer examination, it's evident that this industry is under strain. Growth is primarily driven by price increases rather than the addition of new clients, signalling concerns for long-term sustainability. New business growth hovers around 8-9% annually, not enough to adequately bolster the sector. - read more
The New South Wales government has issued a stark warning regarding potential financial consequences if proposed reforms to workplace mental injury laws are delayed further. As an upper house committee gathers to discuss these changes, Treasurer Daniel Mookhey highlights the urgency, stating that setbacks will result in increased premiums. - read more
An Australian travel insurance policyholder faced disappointment as the Australian Financial Complaints Authority (AFCA) denied their claim for reimbursement of costs incurred due to changing travel plans amid threats of a pilot strike. The traveller, who rearranged his flights from Sydney to Vancouver and subsequently to Toronto, had hoped his insurer, AIG Australia, would cover the $5,576 expenses for the rebooked flights and additional accommodation. - read more
When embarking on the entrepreneurial journey of a start-up, it's imperative to safeguard the nascent enterprise with a reliable insurance safety net. Insurance acts as a vital shield, protecting the hard work and innovation of new businesses against unforeseen events and liabilities which can arise in the unpredictable world of start-ups. - read more
When it comes to securing the future of your business, insurance isn't just a safety net; it's a vital tool for stability and growth. As an Australian entrepreneur, navigating the complex world of business insurance can be daunting. That's why understanding the importance of choosing the right insurance cover for your venture is critical for success. - read more
Starting a new business is an exciting and challenging endeavor, particularly in the vibrant and innovative startup landscape of Australia. However, amidst the rush of ideas and the race to launch, many startups overlook the crucial aspect of insurance. Insurance is not merely an additional cost but a vital protective measure that safeguards your emerging business against unforeseen hurdles. - read more
As a business owner, understanding the ins and outs of insurance can feel like navigating a maze. The terminology alone can be daunting, yet it's crucial to grasp these concepts to make informed decisions about protecting your enterprise. - read more
Insurance costs can be a significant expense for businesses in Australia, and it is crucial to understand how they can affect your bottom line. With premiums on the rise, many business owners are looking for ways to cut costs while maintaining the coverage they need to protect their operations. - read more
Knowledgebase
Subrogation: An insurance carrier may reserve the "right of subrogation" in the event of a loss. This means that the company may choose to take action to recover the amount of a claim paid to a covered insured if the loss was caused by a third party.