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Life Insurance Claim and Dispute


Life Insurance Cover Disputes

A life insurance policy can give peace of mind to the buyer, their family and loved ones as a safety net in the event of their passing or permanent inability to work. However, if an insurer disputes or refuses to fully pay out life insurance benefits, it can be a major financial and emotional blow during an already trying time.

If you need assistance getting the life insurance payout you and your family deserve, contact Gerard Malouf & Partners. Our expert lawyers have a track record of taking on the largest insurers in Australia, and winning.

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What does life insurance cover?

In Australia, life insurance describes a variety of policies that a person buys into that can provide for them and their family in the event that a catastrophe, such as death or a serious injury or illness occurs. These schemes are paid into by the policyholder over an extended period of time before being paid out in the event of a death or injury. In many cases, life insurance is offered as part of a superannuation scheme, however this is not always the case.

Some of the most common life insurance offerings in Australia, according to the government’s Moneysmart programme, include:

  • Income protection insurance: This program pays out a large portion — sometimes up to 85% — of your income in the event that you become seriously injured or ill and are unable to work for an extended period of time. This type of policy can be made comprehensive along with other policies, such as total or permanent disability or trauma insurance, and is most often held by self-employed individuals, who don’t have guaranteed sick days through an employer.
  • Life cover: Perhaps the policy type most commonly associated with life insurance, life cover pays out a lump sum to a person’s beneficiaries, typically their spouse and children. In some rare cases, a life cover payout may happen while the policyholder is still alive if they have been diagnosed with a terminal illness. If you don’t have anyone who depends on you financially, a life cover policy may not be necessary.
  • Total and permanent disability insurance: Total and permanent disability, or TDP, is a term for an injury or illness that will keep you from ever returning to a full work schedule. TDP insurance pays out in the form of a lump sum and is meant to cover needs like current and future medical expenses, as well as any major debts, such as a mortgage.
  • Trauma insurance: Trauma insurance, also known as critical illness insurance, pays the policyholder a lump sum in situations where a serious illness or medical emergencies, such as a heart attack, stroke, major brain injury or cancer, prevents them from working. Trauma insurance is meant to cover medical expenses, including both immediate care and long-term costs, like physical therapy or a care facility.

The process for filing a life insurance claim will vary depending on whether your policy was bought through an insurance company, super fund or arrangement with your employer. In every case, it’s important to gather any pertinent documents that can demonstrate the legitimacy of your illness or injury and its impact. Potential examples include medical reports from a doctor, a death certificate or information about your work hours.

While the reasons that a claim would be made and accepted may seem clear, insurance companies continually find ways to reject, dispute or minimise life insurance compensation to their policyholders. Many life insurance policies include provisions that specify some forms of injury, illness or causes of death that aren’t eligible. An insurance company may also refuse to make payouts that fall below a certain balance. Before signing any life insurance agreement, it’s important to read over the policy carefully and make sure it covers your situation. A life insurance dispute lawyer can help to translate the fine print of a policy and be your advocate if a claim is rejected and help you to get the compensation you deserve.


How can a life insurance dispute lawyer help?

Life insurance dispute lawyers are experts in the ins and outs of insurance law and can help you and your loved ones get the compensation you deserve. If you are a life insurance policy beneficiary who feels they have been wronged, a skilled solicitor can help you ensure your insurer performs an internal review of your claim in a timely manner, and then represent you if the issue goes before the Australian Financial Complaints Authority (AFCA) or court.

Insurance companies are required to offer a process for policyholders to dispute their decisions. The internal review process may vary from company to company but should always be your first step on the path to a fair resolution. From there, a solicitor can help you file a complaint with AFCA, which has the authority to overturn the insurer’s decision. While the AFCA may represent an effective path to reprieve, the scheme can only give out smaller settlements, often less than $3,000. For larger claims, legal action against the insurance company will be necessary.

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