Underwriter Screwed up

• 

  holdenmg on 06/10/2017 - 01:54

  Hi,

  I'm wondering if the Life Cover you speak of is ART (Annual Renewable Term)
  and if the Super Fund has changed the Insurer or the Terms of Cover you are now being offered for your renewal.

  Superannuation funds buy policies in bulk and often get a discount from the insurance company. You pay for insurance from your super fund with pre-tax dollars whereas when you buy insurance outside the super fund you use after tax dollars.

  Insurance inside superannuation will often have automatic acceptance (which means you don't have to go for a medical or reveal pre-existing conditions) and it sounds like a very good deal.

  But there can be downsides too.

  Did you keep a photocopy of the Original Proposal or this "signed agreement"
  that your refer to?

  Can you expand on what the Travel Exclusions are in respect to the Life Cover you have. Are you traveling or working somewhere that is specifically precluded?

  • 

    herysoe on 06/10/2017 - 03:01

    +1

    Yes, I have all the signed agreement and nothing in there about the exclusions. Also when the underwriter rang me up, they did tell me they have no record of the signed agreement after the employee left. So I do have all the records.

    The travel exclusions state that no compensation will be paid if I travel to specific country (won't mention the country since it is irrelevant)

    Thanks for your input.

• 

  Kangal on 06/10/2017 - 01:58

  No.

  You're lucky you read the fine print now, before anything happened.
  Ethically, they should reimburse you. But practically, its a losing battle.
  If you paid <$400… I would write it-off, and say its the cost of learning.
  If the amount is significant, then its upto you.

  It's like paying 1 year rego, and then having your car undriveable for 10 months…. you know you aint getting that amount back, any the only resolve is you've caught/stopped payments sooner rather than later.

  • 

    herysoe on 06/10/2017 - 03:02

    Yeah true, if its below <$500 then I would let it go but this is for about $2K (annual payment).

    • 

      Kangal on 06/10/2017 - 03:08

      Ouch.

      It's still an uphill battle, but maybe someone here more experienced might chime in and give you pointers.
      Perhaps you could call the ACCC and get their opinion?
      (Insurance is still a "service" so they should have some consumer protection for you)

      Or better yet, talk to an actual person that works for FOS (Ombudsman)
      http://www.fos.org.au

• 

  whooah1979 on 06/10/2017 - 03:23

  Do you think I should get back what I paid for the last year life insurance? at least.

  Why do you think that they should refund the premium for last year?

• 

  chumlee on 06/10/2017 - 08:25

  how can you get back what you paid last year? they provided you with cover and you accepted it by paying the premium. the exclusions have now changed so now it's up to you if you want to continue with the policy

  • 

    herysoe on 06/10/2017 - 10:55

    The premium I paid when I signed last year did not include the exclusion you see. If there was one, I may not sign then. I have the proof that the offer letter did not include the exclusion. I know about this when the renewal times comes from the insurance company. I never need to check my insurance detail before then.

    • 

      holdenmg on 06/10/2017 - 11:19

      You need to check you got what you proposed (or paid for).

      Most Life Cover has a minimum 14-day cooling-off period. This allows you to check and review the cover is what you had proposed.

    • 

      chumlee on 06/10/2017 - 12:21

      You took out life insurance that has many inclusions and exclusions. Just because you have now noticed one was excluded when you wanted it included doesn't legally give you grounds for compensation.

      You have gained almost all of the benefits of the policy and you didn't need to claim on it so any compensation will be a bonus as goodwill from broker

• 

  RockyRaccoon on 06/10/2017 - 08:29

  Isnt the real issue here, that while you were in the unnamed country you were not covered. Unless there are more exclusions that affect you.

  So you need to decide to fight on the impact that would have had.

  That being the time you were in that country and not covered.

  Eg if you visited for 4 weeks, then your insurance wasnt valid for those 4 weeks, the rest of the year you were covered.

  Is it worth the fight? Only you can decide.

  Life Lesson.

  When dealing with anything important, like finances always get written advice of the agreement. Verbal or even emails are never really acceptable. Official papers like the product disclosure statement (PDS) is what you should rely on.

  If you read these (yep most don't) you will often find what is covered and what is not, and then see if that matches what you have been told.

  That is why most companies give you a cooling off period after you buy, so you can check the details

  However if you feel you have been mislead by the agent then you can follow this up with the FOS. Companies cant hide from this requirement even if the agent has left the company.(copied from one company)

  Financial Ombudsman Service (FOS): an independent body that operates nationally in Australia and aims to resolve certain insurance disputes.
  This service is free of charge to customers. Please note that you must register your dispute with the FOS within two years of receiving a decision from (XYZ) Customer Relations

• 

  Seraphin7 on 06/10/2017 - 11:18

  There is something not adding up here. Underwriters are typically employed by insurers. Are you sure you are not talking about an adviser or broker?

  As regards the country they wish to exclude, is this actually relevant to you? I can imagine scenarios where insurers wish to exclude certain countries due to much higher risk associated with travel to those regions. Will this actually impact you? Or is this some technicality based on them excluding "country X" in some God-forsaken, lawless part of the world that you have never been to and have no likelihood of every actually going to?

  If at the end of all of this, and making sure of all pertinent facts, you think you are still aggrieved you should first raise a complaint with your insurer. Go through the "internal dispute resolution" process. If you are unsatisfied with the outcome of this, you can consider the relevant "external dispute resolution" scheme, which given this is via superannuation is likely to be the Superannuation Complaints Tribunal (SCT), but in any event will be informed to you by your insurer at the conclusion of the internal process.

  • 

    herysoe on 06/10/2017 - 11:43

    sorry, i think you are right, it may be adviser. So I did it thru adviser/broker. I have no issue with the exclusion as long it was mentioned in the first agreement. It is is what it is.

• 

  herysoe on 06/10/2017 - 12:15

  So this looks like an uphill battle but I will try with the adviser/broker to get some compensation of the premium like 50% or 25%, at least something. They need to learn from their mistake and not to screw up with big decision like this. Imagined this, if you died overseas and turn out you weren't covered, and your family or next of kin, had to fight for the claim without any knowledge of the issue, which they will definitely loose.

  Thank you everyone for you input.

  • 

    bhw2282 on 06/10/2017 - 13:16

    Check to see if the adviser accepted the exclusion on your behalf (i.e. electronically via the application software).

    If the software didn't apply the exclusion, then it would be the insurers mistake that they didn't get a signature from you.

  • 

    whooah1979 on 06/10/2017 - 14:33

    compensation of the premium like 50% or 25%, at least something.

    Are you seriously expecting that the insurer refund 50% or even 25% of premium based on an exclusion that may or may not have been in the pds?

    Did you read last years pds before signing the contract?

    • 

      bhw2282 on 06/10/2017 - 15:11

      It really depends on whether or not it was in the PDS.

      If it was, 25-50% is unreasonable

      If it wasn't (and for argument's sake, let's say the adviser didn't auto-accept it on the client's behalf), then it wouldn't be unreasonable to completely void the policy from inception (and get a 100% refund).

    • 

      herysoe on 06/10/2017 - 17:00

      The adviser/broker sent only "statement of advice" in digital form (signed using adobe sign). Nothing else, no PDS. I have searched for the exclusions in the pdf and found nothing. So that is the only document I can show to adviser/broker that nothing was mentioned about exclusion, where as the adviser/broker didn't even have any record of the statement since the employee left.

      • 

        bhw2282 on 06/10/2017 - 19:51

        It does sound highly unusual for an exclusion to just appear a year later without any correspondence being sent to you about it. Double check your initial policy schedule.

        They cannot just apply an exclusion after the policy has started without getting your signed consent first. Raise a complaint with the insurer and ask them to respond to you in writing so you have a record of their explanation

      • 

        herysoe on 07/10/2017 - 02:46

        Thanks for your input. I may start with the insurance company and let them sort it out with the adviser/broker.