Attwood Marshall Lawyers Compensation Law Senior Paralegal Amy Lewis explores a recent horror story where a woman needed to access her insurance policy after receiving a cancer diagnosis, only to discover that she was not covered due to a failure to disclose her complete medical history.
ABC News recently shared the heartbreaking story of Casey-Lee, a 39-year-old mother of two whose life insurance was cancelled by her insurer, MetLife, after she was diagnosed with terminal cancer.
Even though her doctors and independent medical experts confirmed her cancer was not linked to her past urinary tract infections (UTIs), MetLife voided her policy for “non-disclosure.” The insurer claimed that had it known about her previous medical history, it would not have offered her cover “on any terms.”
It is a devastating outcome and, sadly, stories like these are not uncommon.
Anyone completing an insurance application must provide full medical disclosure of their complete medical history to avoid a denial when it comes time to make a claim, especially when changing insurers, including conditions or illnesses that may seem irrelevant or insignificant.
Whether your omission was accidental, based on a misunderstanding or about a condition ultimately unrelated to your claim, the consequences are the same: the insurer can elect to declare your policy void and deny your claim, leaving you without the protection of cover when you need it most.
A heartbreaking example
According to the ABC report, Casey-Lee switched to MetLife for better premiums and increased coverage after building a new house.
When completing her application, she failed to disclose her history of urinary tract infections, previous endometriosis surgery, and a recent GP consultation that led to tests. Those tests revealed bladder cancer.
When Casey-Lee received a terminal diagnosis and attempted to claim on her policy, MetLife voided her policy entirely.
The outcome is particularly tragic because medical experts confirmed there is no link between UTIs and her rare cancer. Had Casey-Lee remained with her previous insurer, she would have been covered.
Instead, an incomplete application during what seemed like a routine insurance upgrade has left her family unprotected. She says she was not trying to deceive her insurer. She did not realise that she had to disclose common conditions like UTI’s.
The importance of getting the right advice from an experienced insurance broker
There are a multitude of products out in the market – we get bombarded with offers from health funds, insurance companies, supermarkets, and credit providers.
Don’t be deceived by these providers and take out cover that does not suit your needs. You should seek advice from an experienced and trusted insurance broker or financial planner in this area when reviewing your existing cover or taking out new policies. It could save you a lot of grief if something catastrophic happens.
An experienced broker or financial planner will take into consideration your unique circumstances, including the type of work you do, what type of cover you need, and how much cover is appropriate to protect your family and personal financial position. They will also select the right policy for you and ensure there are no exemptions that may affect you.
Unfortunately, stories like Casey-Lee’s are far from uncommon. We regularly see clients who discover at claim time that they don’t have the coverage they thought they had. The following cases involve total and permanent disablement (TPD) insurance, but the same disclosure principles apply to all insurance applications – whether life insurance, TPD, or income protection.
Case Study 1: The consequences of incorrect information
Matthew, a young concreter, was left severely incapacitated after an assault. He held $220,000 worth of TPD insurance through his superannuation fund. However, during the claims assessment, the insurer discovered that on his initial application, Matthew had incorrectly indicated he performed non-manual (office) work rather than manual labour.
Based on this incorrect disclosure, the insurer argued that if Matthew had disclosed his occupation correctly, they would have only provided $60,000 worth of cover. Matthew received only $60,000 instead of the $220,000 he believed he was covered for – all because of one incorrect answer on his application form.
Case Study 2: Misinterpreting the questions
James was involved in a major motor vehicle accident and was left unable to return to work. When we contacted his superannuation fund to lodge a TPD claim, we discovered James did not hold any insurance.
The problem? James had misunderstood a question on his application form that read: “Are you applying for, entitled to or been paid a total and permanent disablement (TPD) or terminal illness benefit?”
James, a healthy and working individual at the time, had answered “yes” because he thought the question was asking whether he was applying for TPD insurance. In reality, the question was asking whether he had previously made or was currently making a TPD claim. This single misunderstanding meant James had no coverage when he desperately needed it.
Case Study 3: Minimum balance requirements
Thomas, a young builder injured on a worksite, assumed he was automatically covered for TPD insurance after rolling multiple superannuation funds into one master account. However, because Thomas didn’t maintain the minimum balance required to activate insurance coverage, he was uninsured at the time of his injury – a fact he only discovered when trying to make a claim.
Preventative steps you can take
When applying for insurance:
Take your time with the application process. Read every question carefully and consider what it is really asking. If you’re unsure, query it.
Disclose everything. This means disclosing all past medical conditions, no matter how common or minor they seem (including conditions like UTIs and endometriosis that affect millions of Australians). You must disclose pending tests, investigations, or treatments. And don’t forget about previous surgeries or procedures, regardless of how long ago they occurred, and always provide family medical history if the form asks for it.
Pay special attention to timing. If you have recently seen a doctor or had tests ordered, make sure to disclose this, even if you haven’t received the results yet.
Get professional advice. Engage an experienced insurance broker or financial planner who can guide you through the application process and help ensure you’re answering questions correctly. The cost of this advice is minimal compared to the potential cost of being uninsured.
Keep detailed records. Maintain copies of your application forms and any correspondence with your insurer so you have a clear paper trail.
Review your policy carefully. Once you receive your policy documents, review them thoroughly to ensure all the information is correct and that you understand what is covered and what is not.
When things go wrong
The above cases show the serious consequences that can arise if you are underinsured or not covered at all. These situations can be avoided if you seek proper financial advice before setting up your insurance policies and superannuation funds.
We all hope we never have to claim TPD or terminal illness insurance. Still, just as we take out private health insurance to cover our health-related needs, or car insurance in the event of a car accident, TPD and terminal illness insurance is essential if the unexpected occurs.
Your life and livelihood depend on your income, and so it is imperative to insure yourself in case you can no longer work at the same capacity.
If you find yourself in a situation where your insurer has denied your claim due to non-disclosure or you are facing difficulties with your insurance claim, it is essential to seek expert legal advice immediately.
When it comes to claim time, it pays to engage a firm that specialises in life insurance who can provide guidance throughout the claim and advise of any potential issues.
At Attwood Marshall Lawyers, we can review your policy and application to identify any potential issues, advise you of your rights and options, negotiate with the insurer on your behalf, challenge decisions that may be unfair or discriminatory, and represent you in disputes or at tribunal hearings if necessary.
Early intervention can often make the difference between a denied claim and a successful outcome.
Attwood Marshall Lawyers – experts in TPD and superannuation claims
If you believe you are eligible to make a TPD claim and require assistance, we are here to help. It is our firm’s intent to help people and change their lives for the better.
In some cases, people hold multiple TPD insurance policies across various superannuation funds and may be entitled to make multiple claims.
If you can no longer work due to injury, illness, or a medical condition, we can help you explore any available insurance coverage to get things back on track and achieve financial security.
For a free, no-obligation initial consultation, contact our Compensation Law Department on 1800 621 071 at any time.
