Your rejected severe arthritis or heart attack insurance claim could be valid

If you have severe rheumatoid arthritis or have experienced a heart attack, your insurance claim could now be valid thanks to a decision by MLC to backdate the changes to outdated definitions.

 

The Severe Rheumatoid Arthritis (SRA) definition will be backdated to apply from 1 January 2014 on MLC Insurance Critical Illness Plus and Personal Protection Portfolio (PPP) Critical Illness Plus policies.

 

The updated definition for heart attack will be backdated to apply from 10 September 2012.

 

Medical definitions provided by some insurance companies were upgraded in mid-June 2017, with the new definitions to only apply to future claims.

 

However, a recent review of the outdated definition has provided good news to those with MLC whose claims were previously rejected.

 

Definitions were updated to comply with the Financial Services Council (FSC) Life Insurance Code of Practice. Insurance companies which are FSC members must comply and adopt the new definitions.

 

This followed Australian Securities and Investments Commission’s (ASIC) Inquiry into CommInsure’s practices in March 2017, aimed at strengthening consumer protections, and to remove the ability for insurance companies to use out of date medical definitions to deny claims.

 

Slater and Gordon State Practice Group Leader Sarah Snowden said the change presented an opportunity for MLC insurance policy holders to investigate what they’re entitled to and have their claim reviewed if it was rejected based on the definition of their condition.

 

“Often a doctor’s definition of what you are suffering does not match your insurance company’s definition and that is why these outdated definitions were reviewed in 2017,” Ms Snowden said.

 

“You have the right to have your MLC claim reviewed, if you were knocked back for an insurance claim after a heart attack on or after 10 September 2012, or if you suffer from severe rheumatoid arthritis and your claim was rejected on 1 January 2014 or after.

 

“This is good news for people who have experienced these health conditions, as they have been paying hefty premiums for this type of insurance cover and should seek advice on whether they can have the decision reconsidered or challenged.

 

“If you haven’t made a claim for a few years, our advice would be to take action as soon as possible.”

 

Ms Snowden said there were strict time limits which may apply to the review from the initial claim, which vary depending on where you live in Australia.

 

“It would be best to get your claim reviewed and get legal advice urgently as the timeframe may be limited,” she said.

 

4 June 2019.