QLD CREDIT SHORTFALL POLICY

[Bobbo]

My father took out a credit shortfall policy when he bought a vehicle earlier in the year. Due to a recent heart condition diagnosis he is unable to work and have filed a claim under the policy to have the car payments done. The company is claiming that under the T&C of the policy all benefits are excluded with pre-existing conditions. After going through his policy I couldn't find any mention in the "EXCLUSIONS" section mentioning any pre-existing condtions.

They also claim that his diabetes caused his heart condition but he has been working and living a normal life since his diagnosis of diabetes in 2009. I feel that it is only a medical opinion that diabetes caused his heart condition as there are hundreds of risk factors for Cardiac condition.

Is there any legal grounds to state that his diabetes caused his heart condition and is there anything we else we could do?

 

[Rob Legat - SBPL]

Credit insurance is fairly well known for largely being 'junk' insurance.

Diabetes can have a range of complications, and insurers may try to pin lots of things on it. Assuming your father was diagnosed with diabetes before obtaining his insurance, was he asked about any medical conditions? If so, did he disclose it?

 

[Bobbo]

Credit insurance is fairly well known for largely being 'junk' insurance.

Diabetes can have a range of complications, and insurers may try to pin lots of things on it. Assuming your father was diagnosed with diabetes before obtaining his insurance, was he asked about any medical conditions? If so, did he disclose it?

Hi Rob,
Thanks for your reply. He was diagnosed in 2009 with Diabetes and has been working up to end of July. There was no forms he had to complete when he obtained the insurance. In the 'Welcome Pack ' they were sent there was a form with the Terms and conditions for the insurance. I had a read through and there is no mention of any exclusions for pre-existing illnesses.

 

[Rob Legat - SBPL]

Usually there will be a booklet size document called a Product Disclosure Statement. Did you get / read that?

 

[Bobbo]

The only things they received was an email containing the Welcome letter, Disclosure notice, Policy schedule and policy wording.
I have read through all of these and there is no mention of pre-existing illnesses.
There GP had to fill out a form, and the insurance company says that according to the GP the Heart condition is due to his Diabetes.
Is this not just a medical opinion and not a medical fact that diabetes caused his heart condition?
Because if this is the case, the insurance company won't pay for any of the 'risk factor's' that may lead to Heart failure.

I appreciate your feedback

 

[Bobbo]

Could I perhaps also ask your view regarding a medical opinion and medical fact. Is there any legal basis for them to base there decision on a medical opinion?

 

[Rob Legat - SBPL]

A lawyer who practises in insurance litigation or personal injuries would have a better idea, but my understanding is that medicine is more of an art than a science - so an opinion is more than likely all you're going to get.

I'd say you have two options here:

1. Hire a lawyer to do a thorough review of the cover. That will obviously cost you.

2. Make a complaint to the insurer that their policy doesn't exclude pre-existing conditions and chase it through to any external dispute resolution scheme they have. If it is in there, someone will tell you pretty quickly.