Super Claims Australia’s Superannuation and Disability Insurance Team recently forced QBE who are the insurer for CIP (Construction Income Protection) to change their decision to reject a claim because it arose “directly or indirectly out of an injury or illness for which a statutory transport accident scheme provides compensation and/or damage.” The structure of the law in Queensland means this exception cannot apply to people injured in motor vehicle accidents who are also pursuing a damages claim under the Motor Accidents Insurance Act 1994.
Insurance policies often include exceptions or exclusions which, if they apply to you, will mean you are not entitled to any insurance benefit under the policy even if you have paid all the appropriate premiums. These exceptions are often based on technical legal language. If you do not have a legal background it can be difficult to know if the insurer was technically entitled to reject your claim or if in fact they have misunderstood your factual and/or legal circumstances.
A good example of this has been dealt with recently by the Super Claims Australia Superannuation and Disability Insurance Team. The insurer for CIP (Construction Income Protection) rejected a claim made by one of our clients because they decided it was a claim 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 injuries/illness fell within this category.
The insurer didn’t have the facts wrong. Our client’s income protection claim directly related to injuries caused by a motor vehicle accident and 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. The insurer however did have the law wrong because of a lack in technical understanding of the Queensland legislation. The MAIA does not actually provide compensation and/or damage for an injury. Rather, the MAIA regulates the procedure to follow to bring a common law claim for injury involving a motor vehicle and it is the common law that provides the compensation and/or damage for that injury.
Queensland is different from other states in this way and as most insurers’ have a nationally focused policy, automatic rejection without considering the particular law in Queensland reveals a lack of genuine consideration quite common to the industry.
Insurers and superannuation funds are often guilty of a one size fits all approach to policies and procedures for processing claims and it is simply not the case that this will produce the right result for everyone. If your income protection claim or other disability insurance 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 exception/exclusion must be closely considered and could be challenged.
How can Super Claims Australia help you?
If you have been injured at work or if you are unable to work for any reason, give Super Claims Australia a call on 1800 088 677 or via our online contact form for an obligation free consultation.