A claim for income protection benefits in Queensland has resulted in the insurer making a “one-size-fits-all” mistake and after fighting for his rights the claimant has received the appropriate benefits owed to them.
The insurer for CIP (Construction Income Protection), QBE, rejected a claim made by the claimant as they decided it was arising "directly or indirectly out of an injury or illness for which a statutory transport accident scheme provides compensation and/or damage." Their policy stated they would not pay any benefit to an insured person whose injury or illness fell within this category.
It was found that the client’s claim did relate directly to injuries caused by a motor vehicle accident and that the client was also making a claim for damages based on those same injuries through the Motor Accident Insurance Act 1994 (MAIA) - the statutory transport accident scheme in Queensland.
While this may be deemed enough for rejection in other states, in Queensland the MAIA does not actually provide claimants with compensation or damages for an injury. Rather, the Act regulates the procedure to bring a court claim for injury involving a motor vehicle and it is the common law that provides the compensation or damages for that injury. Once these differences were pointed out to the insurer by Turner Freeman Lawyers QBE changed their decision to reject the claim.
Adam Tayler, special counsel at law firm Turner Freeman Lawyers, who was representing the client, says that, "Many insurers and superannuation funds commit this same error across all manner of claims."
“Insurers and superannuation funds are often guilty of a one size fits all approach to policies and procedures for processing claims. This will never produce the right result for everyone.” Adam Tayler said.
“If your income protection claim is rejected on the basis of a technical exception or exclusion and you are then denied a benefit for which you have been paying premiums, the basis of that must be closely considered and could be challenged.”
"Quite often complicated insurance policies can be easily misinterpreted, even by the insurer. It pays to double check any exclusion to be sure."
It is also noted that in some cases even where an exclusion does apply it can be avoided because of other conduct by the insurer or because it would produce an unreasonably harsh result where the insurer is not otherwise prejudiced.
To learn more about this case, please contact
Turner Freeman Lawyers
Direct line 07 3025 9008
1800 683 928
Turner Freeman Lawyers Qld
Turner Freeman has been providing care, support and outstanding results to our clients for over 50 years. We are a nationwide law firm with specialist offices around the country. We are proud of our long-standing reputation for excellence, and for giving those in need a voice that can be heard.