Insurance claimant wins against insurance and superannuation fund

16 January 2014 | Super Claims Australia

by Adam Tayler

Adam Tayler Superannuation and Insurance Expert

Superannuation and TPD

A claim for compensation at a Queensland court has resulted in the insurer making a “one-size-fits-all” mistake and the claimant receiving the appropriate damages owed to them.

Rejected claim decision overturned with the help of Super Claims Australia

breach of contractThe 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 injuries/illness fell within this category.

Adam Tayler, Super Claims Australia superannuation and insurance expert lawyer representing the client found that the client’s claim did in fact 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 provide compensation or damages for an injury. Rather, the act 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 or damages for that injury. The differences in Queensland law caused QBE to change their decision to reject the claim.

Adam said that many insurers and superannuation funds have this problem.

“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 will get the right result for everyone,” said Adam.

“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.”

If you had a claim rejected we can help you contest the decision

If you had a claim rejected or if you are unsure of what you can do in your situation, give Super Claims Australia a call on 1800 088 677 or via our online contact form for an obligation free consultation.

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