JetSki Insurance Online :: News
SHARE

Share this news item!

AFCA Upholds Fair Evaluation in Insurance Claim Dispute

AFCA Upholds Fair Evaluation in Insurance Claim Dispute

AFCA Upholds Fair Evaluation in Insurance Claim Dispute?w=400
The Australian Financial Complaints Authority (AFCA) has directed MetLife to re-evaluate a policyholder’s income protection claim, focusing on justified interpretations of mental health exclusions.

In a case brought to attention, the claimant, who secured his coverage via superannuation, applied for a $9300 monthly policy intended for a two-year coverage span back in March 2020.

The claimant's struggle began in August 2019 when his general practitioner declared him medically unfit for work due to "significant psychological distress," primarily catalyzed by workplace bullying.

As a recourse, the individual took personal leave in August followed by paternity leave in October of the same year. Although he resumed work in October 2020, he had to suspend his professional engagements again by December.

In September 2021, the claimant submitted a request for income protection benefits, citing an adjustment disorder diagnosed with mixed anxiety and depression as the reason inhibiting his capacity to work.

However, MetLife rejected the claim in July 2022, accusing the claimant of inaccurately representing his medical history. The insurance provider argued that the applicant falsely stated he hadn’t been “diagnosed with or sought medical advice or treatment” for psychological issues at the time of application.

MetLife asserted that the applicant already exhibited psychological distress, hindering his work capability long-term, and had they known, the policy would not have been issued. They determined his stress related symptoms equated “to a psychological condition.”

The claimant countered, maintaining he neither identified with a history of psychological ailments during his application process, nor would a typical person in his context.

AFCA elaborated, saying although the complainant experienced "significant stress in 2019," ordinary perception does not always align stress with a psychological or clinical mental health condition. The inquiry focused on awareness of any conditions at the time, not diagnosis existence.

AFCA highlighted that the treating GP did not insist on mental health assessments commonly expected when symptoms emerge, and the sole "treatment" employed was voluntarily steering clear of the work environment, a decision lacking a formal diagnosis.

They elucidated that “Even if the answers given were not actually true (because with the benefit of hindsight the complainant was in fact suffering from a psychological or mental health condition), the panel accepted a reasonable person in the circumstances would also have reached the same belief as the complainant did.”

Following the conclusion, AFCA mandates MetLife to process and revisit the claimant’s submission and communicate the outcome to Hostplus, the coverage trustee, within a 60-day frame. The original content was reported by the Australian Financial Review.

Published:Friday, 1st Nov 2024
Source: Paige Estritori

Share this news item:

Insurance News

Insurers Face Intense Scrutiny Over Quake Claim Rejections Insurers Face Intense Scrutiny Over Quake Claim Rejections
21 Nov 2024: Paige Estritori

In recent months, Muswellbrook, a town in New South Wales, has experienced a series of earthquakes that have left residents grappling with both physical destruction and emotional distress. Criticism is mounting against insurers as more than 600 claims have emerged, following these seismic events, yet many remain unresolved or denied. - read more
AI Regulations: A Web of Complications AI Regulations: A Web of Complications
20 Nov 2024: Paige Estritori

The Insurance Council of Australia (ICA) has raised concerns about the potential fallout from a fragmented regulatory approach to artificial intelligence and automated decision-making in the industry. There is fear that this patchwork of reforms could result in conflicting requirements, heavier compliance burdens, and increased industry confusion. - read more
APRA Survey Reveals Impact of Climate Change on Insurance Industry Practices APRA Survey Reveals Impact of Climate Change on Insurance Industry Practices
19 Nov 2024: Paige Estritori

A recent analysis by the Australian Prudential Regulation Authority (APRA) reveals that over 90% of general insurers and reinsurers anticipate climate change will influence their underwriting procedures, posing new challenges to the industry. - read more
Fraudulent Claims Lead to Complete Denial of Compensation Fraudulent Claims Lead to Complete Denial of Compensation
18 Nov 2024: Paige Estritori

In a remarkable case highlighting the severe consequences of insurance fraud, an individual's attempt to inflate a theft insurance claim has resulted in the total denial of compensation. Despite a significant portion of the claim being genuine, fraudulent actions negated any potential payout. - read more
Soaring Insurance Premiums Amid Changing Climate Soaring Insurance Premiums Amid Changing Climate
14 Nov 2024: Paige Estritori

As climate change persists, the impact of severe weather on insurance premiums is becoming more evident, pushing affordability out of reach for many Australians. Bernadette Systa, a mother of five, faced an undeniable financial strain as her annual home and contents insurance costs surged from a modest amount to more than twice what she initially paid. This experience echoes a growing dilemma faced by households across the country. - read more


Jetski Insurance Articles

Leak Lockdown: Handling Fuel Spillage and Leaks on Your Jet Ski Leak Lockdown: Handling Fuel Spillage and Leaks on Your Jet Ski
Jet skiing offers a thrilling escape on the water, combining the adrenaline rush of speed with the serene beauty of our aquatic landscapes. However, with the excitement comes the responsibility of maintenance, including the delicate task of managing fuel spills and leaks. These incidents, while hopefully rare, can pose significant challenges for even the most seasoned jet ski enthusiasts. - read more
How to Choose the Best Jet Ski Insurance Policy for Your Needs How to Choose the Best Jet Ski Insurance Policy for Your Needs
Owning a jet ski is exciting and offers countless hours of fun on the water. However, with the thrill comes the responsibility of ensuring your jet ski is protected. This is where having the right jet ski insurance becomes crucial. - read more
Tips for Towing: How to Securely Tow a Disabled Jet Ski Back to Shore Tips for Towing: How to Securely Tow a Disabled Jet Ski Back to Shore
Towing a disabled jet ski back to shore is a scenario that many water sports enthusiasts hope to never encounter. Yet, the importance of being prepared for such an event cannot be overstated. Whether caused by mechanical failure or unforeseen circumstances, when your jet ski succumbs while you’re out on the water, knowing how to securely tow it is essential for the safety of both yourself and your watercraft. - read more
The Ultimate Checklist: Selecting the Right Jet Ski Insurance for Your Needs The Ultimate Checklist: Selecting the Right Jet Ski Insurance for Your Needs
Jet skiing offers an exhilarating mix of high speeds and open water, but it also comes with its share of risks. Just like any valuable property, a jet ski needs protection, not just from potential damage, but also the liabilities that come with operating it. This is where jet ski insurance becomes essential. Having the right insurance coverage ensures that you are financially and legally protected should an accident or damage occur. - read more
Top Mistakes to Avoid When Comparing Jet Ski Insurance in Australia Top Mistakes to Avoid When Comparing Jet Ski Insurance in Australia
Embracing the Australian lifestyle often involves making the most of the surrounding waters, and there's hardly a more exhilarating way to do so than aboard a jet ski. Owning one offers a unique blend of adventure and excitement as you skip over the waves at thrilling speeds. The sense of freedom that comes with piloting your own jet ski is unmatched, making it a favored weekend activity for thrill-seekers and water sports enthusiasts alike. - read more
Protecting Your Jetski Against Theft: Tips and Tricks Protecting Your Jetski Against Theft: Tips and Tricks
Owning a jet ski provides endless hours of fun and excitement, but it’s important to note that these thrill-seeking vessels are a prime target for thieves. According to statistics, jet ski theft in Australia has been on the rise in recent years, with many people falling victim to these crimes. Unfortunately, theft of your beloved watercraft could happen any time, but there are measures you can take to safeguard your asset. - read more
Essential Tips for Choosing the Right Jet Ski Insurance Plan in Australia Essential Tips for Choosing the Right Jet Ski Insurance Plan in Australia
For many Australians, a jet ski is a source of exhilarating aquatic adventures and cherished memories with family and friends. As much as jet ski ownership brings joy and excitement, it carries inherent risks and responsibilities. One crucial aspect of responsible ownership is ensuring that you are adequately protected with the right jet ski insurance coverage. - read more
Tips for Towing: How to Securely Tow a Disabled Jet Ski Back to Shore Tips for Towing: How to Securely Tow a Disabled Jet Ski Back to Shore
Towing a disabled jet ski back to shore is a scenario that many water sports enthusiasts hope to never encounter. Yet, the importance of being prepared for such an event cannot be overstated. Whether caused by mechanical failure or unforeseen circumstances, when your jet ski succumbs while you’re out on the water, knowing how to securely tow it is essential for the safety of both yourself and your watercraft. - read more
How to Choose the Best Jet Ski Insurance Policy for Your Needs How to Choose the Best Jet Ski Insurance Policy for Your Needs
Owning a jet ski is exciting and offers countless hours of fun on the water. However, with the thrill comes the responsibility of ensuring your jet ski is protected. This is where having the right jet ski insurance becomes crucial. - read more
Understanding Jet Ski Insurance: What You Need to Know Understanding Jet Ski Insurance: What You Need to Know
Jet ski insurance is an essential coverage option for anyone who owns a jet ski. While some jet ski owners may not see the need for insurance, it is important to understand the risks involved in owning a jet ski without insurance and the legal implications of not having coverage. - read more


Your free JetSki insurance quote comparison starts here!
First Name:
Postcode:

All quotes are provided free (via our secure server) and without obligation. We respect your privacy.

Knowledgebase
Policyholder:
The individual or entity who owns the insurance policy.