WA Health Insurance Fund breach of contract
- Thread starter win128
- Start date
Dear win128,
Call AFCA and ask if there is anything you can do/complain. However, terms and conditions of a consumer contract like this one can be amended from time to time. Notice is required for changes that cause ”significant detrimental harm” but I am not convinced what you describe above falls under this definition.
Good luck!
-Nighthleyn
Call AFCA and ask if there is anything you can do/complain. However, terms and conditions of a consumer contract like this one can be amended from time to time. Notice is required for changes that cause ”significant detrimental harm” but I am not convinced what you describe above falls under this definition.
Good luck!
-Nighthleyn
hi Nighthleyn,
does the attached convince you otherwise? have all full correspondance trail backing up all allegations.
does the attached convince you otherwise? have all full correspondance trail backing up all allegations.
Attachments
Dear win128,
Alleged breach of agreement - Unfortunately no - I read each document - there is no law broken by the insurer per se. I am not even convinced notice is required for the subject matter. And you don't really have evidence in the attachments above - that letter from the insurer isn't part of the agreement you had with them, or arguably isn't inconsistent with the terms and conditions/definition of appropriate ground to going overseas - and to be more thorough I even checked HBF's terms and conditions between 2010-now online - I didn't identify anything that suggests the insurer must agree with your request to extend the suspension of insurance without penalty from 1 year to 4 years.
Alleged unfair dealing with you - unclear - maybe you can prove in a tribunal that the insurer's decision, while seems to be legal, would create hardship/unfair in your case/improper/didn't account for all details. Need much more details.
Also - what is this "case description" document? Are you seeking proper legal advice? If so, you need to provide more details - e.g. date of insurance commencement, documents you had signed, copy of all or any notice received from the insurer, how and what was done when you were dealing internally with the insurer. You were vague in the documents above, but it seems relevant if you have any evidence why you are overseas and want to extend and extra 3 years, and why even with 1+ years overseas that you are travelling and not living overseas (e.g. ATO definition is >1/2 year/183 days outside of Australia to be a non-tax resident, insurer likely would bring this up saying they are generous already etc).
I am not suggesting you have no case - I am suggesting if you wish to pursue further e.g. Commonwealth Ombudsman complaint, you need to focus a lot more on evidence that the insurer erred in considering you to have resided permanently overseas, or the insurer erred in how they had dealt with your dispute. Right now, with the information you put to us, you would be disadvantaged before a tribunal.
FYI - you have 3 months from the date of the final response from the insurer if you wish to bring complaint, that presumably means 12 November 2022.
Good luck!
-Nighthelyn
(Edit: AFCA doesn't deal with private health insurance - it is actually Commonwealth Ombudsman Private Health Division that provides external dispute resolution complaints. I've updated my answers).
Alleged breach of agreement - Unfortunately no - I read each document - there is no law broken by the insurer per se. I am not even convinced notice is required for the subject matter. And you don't really have evidence in the attachments above - that letter from the insurer isn't part of the agreement you had with them, or arguably isn't inconsistent with the terms and conditions/definition of appropriate ground to going overseas - and to be more thorough I even checked HBF's terms and conditions between 2010-now online - I didn't identify anything that suggests the insurer must agree with your request to extend the suspension of insurance without penalty from 1 year to 4 years.
Alleged unfair dealing with you - unclear - maybe you can prove in a tribunal that the insurer's decision, while seems to be legal, would create hardship/unfair in your case/improper/didn't account for all details. Need much more details.
Also - what is this "case description" document? Are you seeking proper legal advice? If so, you need to provide more details - e.g. date of insurance commencement, documents you had signed, copy of all or any notice received from the insurer, how and what was done when you were dealing internally with the insurer. You were vague in the documents above, but it seems relevant if you have any evidence why you are overseas and want to extend and extra 3 years, and why even with 1+ years overseas that you are travelling and not living overseas (e.g. ATO definition is >1/2 year/183 days outside of Australia to be a non-tax resident, insurer likely would bring this up saying they are generous already etc).
I am not suggesting you have no case - I am suggesting if you wish to pursue further e.g. Commonwealth Ombudsman complaint, you need to focus a lot more on evidence that the insurer erred in considering you to have resided permanently overseas, or the insurer erred in how they had dealt with your dispute. Right now, with the information you put to us, you would be disadvantaged before a tribunal.
FYI - you have 3 months from the date of the final response from the insurer if you wish to bring complaint, that presumably means 12 November 2022.
Good luck!
-Nighthelyn
(Edit: AFCA doesn't deal with private health insurance - it is actually Commonwealth Ombudsman Private Health Division that provides external dispute resolution complaints. I've updated my answers).
thanks for your considered reply Nighthelyn. i would have thought that the 2010 letter constituted an agreement-contract. HBF had already agreed to the terms and conditions for 12 years. now HBF has decided that it no longer wants any part of this.
i agree... no "law" broken but for the 2010 agreement-"contract", in my lay-person's reckoning, was indeed broken i would have thought. HBF and i had an agreement based on that specific 2010 document. any documentation prior to that has no relevance to the act of "suspension" itself, i would have thought. btw, from memory... the policy was taken out wholelly in my own name in '99 (from memory) and prior to that, i was under the "family" coverage with HBF; i cant understand why this would be relevant to this "policy suspension case" though.
the thing was that the term period of suspension was never clearly defined and was open-ended therefore policy had been suspended for 12 years now. i wonder would i truly have to prove that i have not left Australia permanently? how would i go about doing that i wonder.... i havent renounced my citizenship... so at some stage, i will have to return to Australia permanently. surely i dont have to jump through such hoops as to prove hardship etc.... and pander to and be forced to counter the excuses of the party who's trying to wiggle its way of out all this? shouldnt the onus be on HBF to legally justify its decision and action since its reneging on the agreement-contract and is the instigator?
the issue is no longer a matter of simple extension - that has passed since HBF rejected my original offer at accepting a 3yr extension starting 1 Aug 2022 the date HBF chose to have the new suspension rule come into force.; the 2010 agreement-contract is open-ended as HBF wasnt specific enough.
the "case description" document is my attempt at explaining what's going on and is part of a package i sent out to various law firms.
the "evidence" i have left out in this here conversation is basically the complete correspondence trail between HBF and me about this policy suspension issue showing the various contradictory and devious ways HBF has been trying to weasel its way out of what i perceive is its commitment to me.
you're right about the Commonwealth Ombudsman... i've come to that conclusion too. i've also seen some mention of having up to 2 years from date of "incident" to lodge a complaint through the ombudsman... i gotta find that reference again though.... and up to 6 years for initiating civil litigation. we'll see if HBF gives any formal written notice post 1 Jan 2023. wonder if it means that no statute of limitations exists if HBF fails to give formal termination notice. NOTE: HBF is still holding onto some of my money - again, i would have thought that in itself means that there's a contract.
thanks again Nighthelyn, things to consider. attached is an opinion by a lawyer as to what constitutes a contract and what i thought made my case with the 2010 "letter" plus some other documents i dug up. notice in the last one how HBF changes the goalposts depending on the case and has the "new rule" is selectively enforced retroactively. if right from the start HBF said it was bringing in a new rule active 1 Aug 2022 and says those affected were allowed a maximum 3yr extension from 1 Aug 2022, that would have been fair; as it is now, if this case can be argued successfully in a formal sense, HBF would be proven to have put itself in legal and financial jeopardy through its actions and behaviour.
i agree... no "law" broken but for the 2010 agreement-"contract", in my lay-person's reckoning, was indeed broken i would have thought. HBF and i had an agreement based on that specific 2010 document. any documentation prior to that has no relevance to the act of "suspension" itself, i would have thought. btw, from memory... the policy was taken out wholelly in my own name in '99 (from memory) and prior to that, i was under the "family" coverage with HBF; i cant understand why this would be relevant to this "policy suspension case" though.
the thing was that the term period of suspension was never clearly defined and was open-ended therefore policy had been suspended for 12 years now. i wonder would i truly have to prove that i have not left Australia permanently? how would i go about doing that i wonder.... i havent renounced my citizenship... so at some stage, i will have to return to Australia permanently. surely i dont have to jump through such hoops as to prove hardship etc.... and pander to and be forced to counter the excuses of the party who's trying to wiggle its way of out all this? shouldnt the onus be on HBF to legally justify its decision and action since its reneging on the agreement-contract and is the instigator?
the issue is no longer a matter of simple extension - that has passed since HBF rejected my original offer at accepting a 3yr extension starting 1 Aug 2022 the date HBF chose to have the new suspension rule come into force.; the 2010 agreement-contract is open-ended as HBF wasnt specific enough.
the "case description" document is my attempt at explaining what's going on and is part of a package i sent out to various law firms.
the "evidence" i have left out in this here conversation is basically the complete correspondence trail between HBF and me about this policy suspension issue showing the various contradictory and devious ways HBF has been trying to weasel its way out of what i perceive is its commitment to me.
you're right about the Commonwealth Ombudsman... i've come to that conclusion too. i've also seen some mention of having up to 2 years from date of "incident" to lodge a complaint through the ombudsman... i gotta find that reference again though.... and up to 6 years for initiating civil litigation. we'll see if HBF gives any formal written notice post 1 Jan 2023. wonder if it means that no statute of limitations exists if HBF fails to give formal termination notice. NOTE: HBF is still holding onto some of my money - again, i would have thought that in itself means that there's a contract.
thanks again Nighthelyn, things to consider. attached is an opinion by a lawyer as to what constitutes a contract and what i thought made my case with the 2010 "letter" plus some other documents i dug up. notice in the last one how HBF changes the goalposts depending on the case and has the "new rule" is selectively enforced retroactively. if right from the start HBF said it was bringing in a new rule active 1 Aug 2022 and says those affected were allowed a maximum 3yr extension from 1 Aug 2022, that would have been fair; as it is now, if this case can be argued successfully in a formal sense, HBF would be proven to have put itself in legal and financial jeopardy through its actions and behaviour.
No one has the right to apply any new conditions retroactively. Many companies can do this, but you can sue such companies for it. I have a private policy from the clinic where I work as a nurse. This policy is something that also applies to my husband and daughter. I'm glad that we rarely get sick. But even if that's the case, the policy makes me feel relaxed. I also want to choose a private company in the future to conclude a life insurance contract. Consultants of medical professionals in financial matters from www.thefinitygroup.com guarantee that they'll help me deal with future life insurance. Are there people here who have insured their lives? I want to ask you a few questions.
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