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QLD TPD Insurance Policy - Duty of Disclosure?

Discussion in 'Insurance Law Forum' started by k5498, 28 January 2016.

  1. k5498

    k5498 Member

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    Hi,

    I have a life and TPD insurance policy that was taken out in 2006 approx. 400k. In 2010, I went for an MRI and there was an incidental finding, an anomaly on the brain stem. Incidental findings suck in every possible way because the stress of thinking you have a brain tumour is seriously debilitating at first.

    I had MRIs to monitor it every 6 weeks, then it was pushed out to 3 monthly and then 6 monthly. Fortunately for me, this is a stable non-growing thing and as such there is no diagnosis, no symptoms related to it at all. I still go for the 6 monthly MRI.

    In 2013, I had the opportunity to increase my cover by 25% with no medical evidence. I saw this as a great opportunity to take more cover. In my position, please understand that I would never have knowingly, intentionally done anything to the detriment of the policy. My daughter is now getting a policy and asked me about mine. She brought to my attention that I must have signed a duty of disclosure and that I should have told them about the MRI monitoring. As far as I could see then and still do see, there was and is no pre-existing "condition".

    Having read the act, it seems that after 3 years, the life insurance company cannot void the policy but may revert it back to the original amounts before the upgrade - I could live with this anyway.

    If fraud is proved they can void anytime.

    The 3 years are up in June this year.

    Question

    Have I been fraudulent?

    Does an undiagnosed, asymptomatic, untreated thing need to be mentioned?

    If I tell the insurer about it now, do you think all would end badly or am I better off waiting til 3yr period is up and tell them or just leaving it?

    Any advice would be greatly appreciated as I would rather sort this out now than my family be stuck with a
    problem later down the track.
     
  2. JS79

    JS79 Well-Known Member

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    By failing to disclose your condition they can consider you fraudulent and they can cancel your insurance.

    They would have access to medical records so they will be able to see it. It would probably be better to disclose rather than be found out and have your policy cancelled.
     
  3. k5498

    k5498 Member

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    That's the problem JS79, it's easy to see it as a "condition", however is it a "condition"?

    I am sure that legally it would be challenging to prove that this is a "medical condition". Medical evidence would show that yes, there has been an investigation, but the insurer did not require medical evidence.

    Should I have mentioned my yearly prostate check as well?

    I will let you know how this pans out. My thoughts are to go to the insurer and explain the issue, ask them to reinstate the previous policy as it was and hope they don't void it.

    Not happy with the adviser because when he came to see me, I asked him about increasing the policy with no medical evidence and he tried to get me to rather take out another policy. I then explained the issue to him and he agreed that it would be difficult for me to get another policy on the same terms. He then gladly gave me the forms to complete for the upgrade and lodged them!!!

    Obviously, if I had known the extent of the duty of disclosure I would never have applied for the increase.

    I think there needs to be more wording that advises the layman exactly what he is doing and how it can adversely affect his/her policy because it's obvious the advisers are not explaining properly and the insurers are getting nice little opportunities all the time from silly people like me that will help them void policies. Very sad.
     

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