I received bad advice from my insurer. What should I do?

Published 14 Oct 2015

If you have been forced to claim on your total permanent disability (TDP) or worker compensation insurance following an injury or illness, were you happy with the results?

A TDP is typified by a person's inability to work due to an accident, injury or medical condition. When gainful employment is out of reach and that person meets an age requirement (commonly under 65), they can often make a TDP claim to cover their healthcare and living expenses.

However, some things can impact a policyholder's ability to pursue a successful claim, including whether he or she declared a pre-existing medical condition when taking out their insurance.

This leaves a gap in accountability. Many initial conversations between the insurance provider and the person seeking coverage take place over the phone or in person, meaning such situations can be restricted by a lack of a paper trail.

Did you receive bad advice?

If you receive bad advice, you may find that you are not covered to the standard you first believed, leaving you without access to precious benefits should you suffer a TDP.

It has been a stubborn problem for some time. In fact, the standard of oral advice was highlighted in the Private Health Insurance Ombudsman's (PHIO) most recent quarterly bulletin.

In the April to June 2015 period, the No 1 cause for complaints to the governing body was in regards to satisfaction over the advice provided by the insurance provider. In total, there were 128 complaints made to the ombudsman in the second quarter, 129 in Q1, and another 128 made in the concluding part of last year.

These included allegations that the insurance provider's staff "misadvised a consumer" leading to them taking out an incorrect level of cover. What's more, policyholders have 30 days to make any changes to their new policy, though the PHIO said many do not realise any mistakes until it's too late.

"As part of the office's role in addressing areas of systemic complaint we have assisted some insurers to improve their processes and, in particular, their responses to allegations of incorrect oral advice," the ombudsman explained.

"In addition, we have recommended that after a policy is commenced over the phone or at a retail office, a special emphasis be put on the importance of checking the written policy information and that it matches what was asked for."

What can you do?

If you believe you were misadvised about the details of your insurance policy, you may have grounds to launch a legal dispute. Those with a total permanent disability are forced to lead substantially more complex lives, and the financial support they receive is integral to maintaining their comfort.

In such an instance when bad advice is given - either orally or by any other means - a dedicated lawyer  can help you and your family determine whether there is a likelihood of winning compensation. Once this has been decided, they can also assist by compiling all the necessary evidence to support your claim and help you get the compensation you deserve.

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