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).