Household Insurance Online :: News
SHARE

Share this news item!

AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case

AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case

AFCA Upholds Insurer’s Decision in Breast Cancer Claim Case?w=400

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

A recent ruling by the Australian Financial Complaints Authority (AFCA) has affected a woman’s critical illness claims, as her diagnosis came within mere days of her policy's eligibility period drawing to an end.

The woman was diagnosed with cancer in her right breast on October 5 of last year, followed by the discovery of cancer in her left breast eight days later. She filed claims under her critical illness policy that she had obtained on July 17.

However, TAL Life, her insurance provider, rejected the claims based on the policy's three-month qualifying period for cancer coverage.

In its ruling, AFCA noted that the policy had provisions to potentially waive the qualifying period if the policyholder could prove they were insured either under a previous TAL policy or by another insurer for the same events, right before their new coverage commenced.

The claimant contended that she had cancer coverage through an insurance policy provided by her husband's employer. She presented a letter from the employer affirming that she was covered under a "life, accident, critical illness, and medical insurance" scheme from August 2020 until June last year. Additionally, she showed documentation indicating her husband’s policy did include critical illness coverage for spouses, encompassing cancer.

While AFCA accepted the availability of this cancer coverage, it was not convinced that she held such coverage "immediately before the current policy began." It also noted she had failed to disclose her previous insurance when applying for the new policy with TAL Life.

"There is no information before me about the extent of the critical illness cover the complainant had, if any, through her husband's employer’s insurance arrangements," AFCA’s ombudsman stated.

"Furthermore, it appears that any cover she might have had ceased about a month before the new policy started. I am not convinced there was 'continuity of cover' as suggested by the complainant."

The ombudsman expressed AFCA’s sympathy towards the claimant, especially given that the diagnoses occurred "very close to the end of the qualifying period." Nonetheless, he emphasized that there was no valid reason for the qualifying period to be dismissed.

"The qualifying period is reasonably short and its existence is not unjust. These terms are part of all insurance policies and they draw necessary boundaries. The enforcement of these terms is not inherently unfair," the ombudsman elaborated.

For a more detailed account of the ruling, refer to the original report by AFCA.

Published:Wednesday, 4th Sep 2024
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Australian Insurers Report Record Profits Amid Public Scrutiny
Australian Insurers Report Record Profits Amid Public Scrutiny
20 Nov 2025: Paige Estritori
The Australian general insurance industry has reported an after-tax profit of $7.3 billion for the last financial year, marking its strongest performance in over a decade. This significant profit surge is attributed to lower-than-expected catastrophe losses and robust investment returns. However, this financial success has sparked public discourse regarding the fairness of pricing practices and the overall perception of the industry. - read more
ASIC Highlights Compliance Risks in Insurers' Claims Handling Practices
ASIC Highlights Compliance Risks in Insurers' Claims Handling Practices
20 Nov 2025: Paige Estritori
The Australian Securities and Investments Commission (ASIC) has identified significant weaknesses in the claims handling practices of several insurers, raising concerns about potential compliance breaches. The regulator's recent review points to deficiencies in the oversight of expert reports and inadequate communication with consumers regarding cash settlement offers. - read more
Australian Insurers Brace for Earnings Slowdown After Record Profits
Australian Insurers Brace for Earnings Slowdown After Record Profits
20 Nov 2025: Paige Estritori
After achieving a return on equity (ROE) of 19% in the last financial year-the highest in a decade-Australian general insurers are preparing for a moderation in earnings growth. Consultancy firm Finity projects that the industry's ROE will decrease by six percentage points to 13% in the current financial year, aligning with the target range of 10% to 15%. - read more
Rising Liability Costs Put Pressure on Australia's Leisure Sector
Rising Liability Costs Put Pressure on Australia's Leisure Sector
20 Nov 2025: Paige Estritori
The Australian Amusement Leisure & Recreation Association (AALARA) has raised concerns over the escalating costs of public liability insurance, which are placing significant pressure on amusement and recreation operators across the country. This warning follows the Insurance Council of Australia's (ICA) recent call for reforms to civil liability laws. - read more
New Report Highlights Insurance Challenges for Australian Small Businesses
New Report Highlights Insurance Challenges for Australian Small Businesses
20 Nov 2025: Paige Estritori
A recent report by the Australian Chamber of Commerce and Industry (ACCI) has revealed that small businesses in Australia are paying up to 30% more for their insurance premiums due to taxes and levies imposed by state and territory governments. This financial burden is leading to a worrying trend where an increasing number of small businesses are either underinsuring or forgoing insurance altogether. - read more


Household Insurance Articles

10 Common Household Insurance Policies: What Aussie Families Need to Know
10 Common Household Insurance Policies: What Aussie Families Need to Know
Household insurance is an essential aspect of financial planning for Australian families. It provides peace of mind and financial protection in case of unexpected events such as natural disasters, theft, or accidents. Given the unpredictable nature of life, having the right insurance policy can safeguard your home and its contents, ensuring that you are not left in a financial bind when disaster strikes. - read more
The Most Common Mistakes in Household Insurance Claims and How to Prevent Them
The Most Common Mistakes in Household Insurance Claims and How to Prevent Them
Household insurance is a crucial safety net for both homeowners and renters in Australia, offering protection against a range of potential damages and losses. Navigating the insurance claims process, however, can often be challenging and fraught with pitfalls. - read more
How to ensure your home renovation is covered by your insurance policy
How to ensure your home renovation is covered by your insurance policy
Renovating your home can be an exciting time, but it can also be a stressful one. There are so many things to consider and plan for, including financing the renovations, choosing the right contractor, and selecting the materials to be used. One aspect that often gets overlooked during planning is the impact that renovations can have on your insurance coverage. - read more
Building Your Safety Net: Understanding Total Replacement Cover
Building Your Safety Net: Understanding Total Replacement Cover
For many Australians, their home is their castle, their sanctuary, and most significantly, their largest investment. Safeguarding this asset against unpredictable events is not merely a consideration—it's a necessity. That's where Total Replacement Cover comes into play. But what does this term really mean, and why is it paramount when it comes to choosing a home insurance policy? - read more
The Ultimate Checklist for Comparing Home Insurance in Australia
The Ultimate Checklist for Comparing Home Insurance in Australia
Embarking on the journey of homeownership is a landmark event full of anticipation and dreams. As Australians, we cherish the sanctuary of our homes against the backdrop of our incredibly diverse and sometimes unpredictable climate. However, with this excitement comes a significant responsibility—protecting your investment with the right home insurance. - read more


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

Insurance quotes are provided free and without obligation by a specialist from our national broker referral network. See our privacy statement for more details.


Knowledgebase
Reinsurance:
Insurance that an insurance company purchases from another insurance company to mitigate risk.