DDA conciliation: insurance

Conciliated outcomes: insurance and superannuation

Last updated: October 2009. For more recent outcomes please refer to the Commission's conciliation register

Income protection cover restored

A man who is HIV-positive and runs his own business complained that, when he disclosed his HIV-positive status, his accident and insurance cover provider cancelled his cover. The complaint was resolved when the insurer agreed to provide renewed cover, without additional premium but with an exclusion clause specific to the complainant's situation and subject to an annual medical certificate from his doctor.

Insurance exclusion narrowed

A woman who had experienced a whiplash injury some years ago complained that when she sought income protection insurance, she was only offered cover which excluded all spinal injuries or conditions. The complaint was resolved when the insurer reconsidered and offered insurance which only excluded the pre-existing injury rather than spinal injuries in general.

Income protection for man will depression

A man who is receiving treatment for a depressive illness complained that he had been refused income protection insurance. The complaint was resolved when the insurer advised that it had re-assessed the application and would provide cover, apologised and agreed to provide $10,000 compensation.

Insurance for man with bipolar disorder

A man who has bipolar disorder complained that he had been refused life and income protection insurance. The complaint was resolved when the insurer agreed to issue him a policy with an exclusion clause for events caused by his pre-existing condition.

Insurance and circumstances of dependents

A woman complained that she was not able to extend cover on her insurance policy to her son under the insurer's discounted scheme for dependent students, because although her son was a student, his disability meant he was unable to undertake an approved course of study for the minimum hours required for the scheme. The complaint was resolved when the insurer advised it would provide the cover requested.

Limits lifted on superannuation benefits

A public servant complained that he was being discriminated against because, due to his history of depression, his superannuation policy would exclude any benefits if he died for any reason in the first three years. The complaint was settled when the scheme agreed to seek approval (requiring ministerial and legislative action) to remove this excessively broad exclusion of benefits and provide for full benefits to be paid if death was not due to a pre-existing condition.

Insurance and pre-existing conditions

A woman who has medical conditions affecting her circulatory system and had a melanoma 13 years ago complained that her insurer had refused to renew her accident/sickness insurance policy which had previously been issued subject to an exclusion for pre-existing conditions. The respondent insurer advised that due to poor financial performance in the accident and sickness insurance area it had withdrawn most of its products in this area and its remaining product involved automatic declining of cover to people with any pre-existing condition affecting risk. It referred to amended guidelines from its underwriters, a lack of in-house underwriting capacity to assess risks where a person had a pre-existing condition, to similar recent practice by larger insurers. The matter was however settled with compensation of $3000 and reinstatement of insurance cover subject to an exclusion for known pre-existing conditions.

Income protection insurance secured

A woman who had experienced episodes of depression in the past complained that she had been refused income protection insurance. The insurer had advised that it could not offer a policy with exclusions for depression related claims and therefore had to refuse cover completely. The complaint was settled when the insurer revised its policy and agreed to provide cover with an exclusion for depression.

Income protection insurance and depression

A woman who has a depressive illness complained that she had been discriminated against when her application for income protection insurance was refused and no alternative offered such as coverage being offered with a depression exclusion clause. The complaint was settled with payment of $4000 compensation.

In another case, a woman who experienced post natal depression five years ago and remained on anti-depressant medication complained that she had been refused income protection insurance. The complaint was settled when the insurer agreed to issue a policy with an exclusion for claims related to depression.

Income protection insurance

A man who is paraplegic complained that he had been refused income protection insurance on the basis of his disability. The complaint was settled when the insurer agreed to issue a policy with an exclusion clause for claims arising from the complainant's existing disability.

Health insurance for infertility treatment

A woman complained that her health insurance fund had discriminated against her on the basis of her disability, infertility, by imposing a three year benefit limitation period before she could become eligible to receive cover for IVF treatment which she has been undergoing, while other treatments are covered after one year's membership. The matter was resolved after a conciliation conference with the insurer agreeing to reimburse treatment costs to date and to review its policy on limitation periods. (2001)

Insurance and post natal depression

A woman who had experienced post-natal depression (PND) complained that she had been discriminated against by being refused insurance. She complained of sex discrimination as well as disability discrimination, since PND only affects women. The insurer responded that it assessed PND in the same way as other forms of depression based on underwriting manuals which do not make distinctions as to cause of depression. After a conciliation conference the insurer agreed to provide insurance coverage at standard rates as she was able to provide medical evidence that she had recovered from PND. The insurer also agreed to pay compensation, and to write to the international underwriting companies it deals with to highlight the fact that PND is a specific category of depression with different effects and duration to other forms of depression. (2001)

Death and disability cover secured with limited exclusion clause

A woman with a psychiatric disability (a manic condition) complained that she had been refused death or disablement cover because of her disability which she had disclosed to the insurer. In conciliation discussions the insurer advised it was prepared to insure the complainant provided she submitted a medical report regarding risks arising from her disability. The complainant provided a medical report and the respondent subsequently provided her with insurance cover with no restriction on death but with a restriction for the disablement cover for permanent disablement arising from her current disability. This resolved the complaint. (2001)

In another case, a carpenter complained that he had been refused personal accident / sickness insurance because of a single psychotic episode eighteen months earlier. The complaint was settled when the insurer offered cover with an exclusion clause covering psychotic illness (2001).

Better communication about insurance eligibility

A woman with bi-polar disorder complained of discrimination after her application for mortgage protection insurance was refused. At a conciliation conference it was agreed that she should have been provided with better information on the reasons for declining her application and on alternative products provided by the insurer for which she could have been eligible. The insurer apologised and agreed to pay $5000 compensation. (2000)

Income protection insurance and HIV risk

A gay man complained he had been discriminated against on the basis of an imputed future disability (that is, the risk that he might become HIV positive) when an insurance company refused to give him income protection insurance, even with an HIV exclusion clause (which the complainant was prepared to accept), for longer than a two year period. The matter was settled without admission of liability when the insurer advised that it had reconsidered its decision and was prepared to remove the two year limitation and issue the policy as requested (1999).

HIV risk managed

A man complained in 1995 that he had been refused income protection insurance after disclosing that he was homosexual and had been in a relationship with a HIV positive man, although he himself was HIV negative. The matter was settled without admission of liability with an apology, compensation of $8500 and insurance being issued subject to an AIDS exclusion clause (1997).

Income protection insurance for vision impaired woman

A woman who is legally blind complained in 1995 that she had been discriminated against when an insurer advised her that she would be ineligible for income protection insurance because of her disability. The matter was settled without admission of liability when the insurer provided an apology and $2000 compensation, and undertook to consider a fresh application for insurance (1997).

Blindness and income protection insurance

A computer programmer wished to protect his family income in the event of illness or accident preventing him from carrying out his usual employment. He has a vision disability which may result in his being totally blind in a few years. His applications for income protection insurance were refused. The traditional position of insurance companies is to deny disability income insurance to people who have vision disabilities on the assumption that they are at greater risk of becoming unable to work.

The complaint was settled without admission of liability on the basis that the insurer provided the complainant with disability income insurance with a blindness exclusion. It also revised its policy in relation to people who have vision disabilities. In future it will be prepared to provide blind applicants with long term cover subject to a blindness exclusion. This means disability directly related to blindness is not covered. Each case will be individually underwritten in the usual way with the provision of cover being dependent on the insurer's assessment of the risk attached. The majority of blind applicants who are permanently employed at income levels at the insurers standard level of acceptance, who are well adjusted to their blindness and who satisfy the insurer's usual requirements for occupation, health and pursuits will be eligible for cover on standard terms, subject only to the blindness exclusion (1997).

Loan insurance for woman who had had melanoma

A woman complained in 1994 that she had been discriminated against when she was refused loan insurance after disclosing on the application form that she had received treatment for melanoma. The tumour had been removed 14 years previously without recurrence or spread. She had requested reconsideration of the decision in the light of a medical report but this had been refused. She went ahead with the loan without insurance but complained seeking to secure insurance cover. The insurer expressed concern that the medical reports provided had not satisfactorily addressed issues of probability of morbidity (illness or disability) rather than only mortality, noting that the policy would cover disability as well as death. After an additional medical report was obtained addressing these issues satisfactorily the complaint was settled without admission of liability on the basis that the insurer agreed to provide insurance cover for the remaining period of the loan without charge (1996).

Travel insurance for mental disorder

A man complained that he had been discriminated against on the basis of the disability of his son when his insurer refused to pay a claim on a family travel insurance policy after the son had a panic attack in flight and the family had to return home. The claim was refused on the basis that the claim arose from a mental or nervous disorder which was excluded by a clause in the policy. The matter was settled without admission of liability by payment of medical, travel and accommodation expenses (1996).

Endowment insurance for boy with Tourette's syndrome

A parent complained that his son had been discriminated against by being refused life insurance/endowment insurance cover on the basis that he had Tourette's Syndrome and attention deficit disorder. The complaint was settled without admission of liability with an agreement by the insurer to provide the cover as applied for, and to update its assessment manual to include these conditions. The insurer noted that this decision was made in the context of the particular insurance contract and the health of the particular person concerned and that any similar applications in future would have to be considered individually (1996).

Blindness exclusion clause narrowed

A woman with vision impairment complained that she had been discriminated against by an insurer only being prepared to issue her with a life insurance policy subject to an exclusion clause where blindness contributed to accidental death. The insurer had regarded this as reasonable by reference to actuarial data and other evidence and thus as lawful under DDA section 46. After further discussion the insurer determined that the underwriting manual it was using had been outdated. The matter was settled without admission of liability with the policy being re-issued with a modified exclusion clause covering only situations where blindness is a symptom of a primary health condition leading to death, and a policy change to take blindness into account only where material to the risk and then to apply more up to date underwriting guidelines to determine whether the proposal should be accepted with or without some additional premium loading (1996).

Mistaken refusal of superannuation cover remedied

A woman complained that she had been discriminated against in being refused disablement cover as part of her superannuation scheme. She believed that this was because she had disclosed a mild anxiety condition which required infrequent hospitalisation and which had never required hospitalisation or time off work. The respondent indicated that the refusal of cover had been an administrative error, since employees in the complainant's employment category were entitled to automatic cover without a personal health statement being required. The complaint was settled without admission of liability with provision of unrestricted disablement cover (1996).

Employer complaint achieves superannuation cover for employee

An employer complained on behalf of an employee with a vision impairment that the employee had been discriminated against in the terms and conditions of membership of a superannuation fund. The employee had applied for and been refused additional cover beyond his automatic entitlements. The complaint was settled without admission of liability by an agreement to provide the additional cover subject to exclusion clauses which restricted benefits payable in respect of eye diseases or disorders (1996).

Income protection insurance dispute resolved with agreement to obtain additional medical report

A woman complained that she had been refused income protection insurance because of diabetes. The insurer advised that they did insure people with diabetes although some additional premium might be incurred depending on the severity and management of the condition. The complainant's application had been rejected because in addition to diabetes she had multiple medical problems which placed her outside acceptable underwriting guidelines. The complaint was settled without admission of liability on the basis of this explanation and an undertaking by the insurer to consider a further application in the light of a further medical report (1995).

AIDS exclusion on death and disability cover

A complaint about exclusion of cover for AIDS related death or disability within two years of joining a plan was settled without admission of liability for $150,000 (1994).

Restrictions reduced on superannuation

A university lecturer who has multiple sclerosis complained that she was being discriminated against in that the superannuation fund of which she was compulsorily a member limited her benefits not only in relation to her pre-existing condition of MS, but regarding any other illness or disability. The matter was settled without admission of liability when the fund advised that benefits would be unrestricted regarding illness or disabilities other than MS pending further amendments to the trust deed which would remove any restrictions on benefits (1994).