Bowen Buchbinder Vilensky

Archive for the ‘Insurance Law’ Category

Why You Should Never Think of Insurance Renewal Notices as ‘Routine’
Friday, September 5th, 2014

lesb

By Les Buchbinder, Director at Bowen Buchbinder Vilensky Lawyers

5 September 2014

When most of us receive renewal letters from our insurers for our house, car or healthcare, we usually focus on the cost of the renewal and ignore the rest of the document.  But spending just a few minutes checking the details and reflecting on what has happened since the last renewal document can mean all the difference between dealing with life’s inevitable challenges with relative ease, or suffering serious financial hardship.

Omitting to mention changes is different from material non-disclosure.  But how are they different?

Omission

Let’s say you buy an expensive new item of jewelry or furniture. When your contents insurance renewal paperwork arrives, because you made the purchase nearly a year ago and don’t spend much time thinking about new capital items, you forget to list it on the renewal document.

Some weeks later there is a burglary.  Apart from having to deal with repairs and disruption, when you put in your claim for the expensive stolen items, the insurer rejects the claim because they were not nominated on your Policy Schedule.

Maintaining an inventory of all items to be listed on a contents insurance policy may seem a tedious task, but it’s an important one.  Forgetting to mention an item on your Policy is, in insurance speak, an ‘omission.’  Material non-disclosure is rather a different matter.

Material Non-disclosure

Let’s use an example from private medical insurance, when a person forgets to mention the fact that he consulted a medical specialist about a back injury a few years before taking out a policy.  Having not had any back problems for years, perhaps it doesn’t even cross his mind when he completes the paperwork.

Fast forward to a weekday afternoon when some routine activity at work results in the person suddenly and unexpectedly putting his back out.  What at first impression seems to be a minor injury seems a lot more problematic after medical examination – he is told by doctors he may need extensive treatment.

If he subsequently makes an insurance claim, the insurer will request a full medical report, including historical records.  The chances of having the much earlier back injury discovered are high – at which point the insurer could reject his claim on the basis that he failed to disclose significant information that was material to whether or not the insurer would have taken on the risk in the first place.  Or, if the insurer had been willing to take on the risk, it would have been for a substantially higher the premium.

After years of faithfully paying their insurance premiums could you be forgiven the sin of omission?  I’ve seen insurance companies reject claims by loyal clients of many years standing.  Whatever the policy wording, insurers do have the discretion to waive potential defences to claims made under insurance policies and nevertheless pay out the claim.  But I wouldn’t count on it!

Renewal notices should never be seen as a routine chore.  They deserve quality time and proper consideration.  Contrary to popular belief, the two words I never want to hear a client say is ‘if only!’

Leave a comment

 

How Best to Submit an Insurance Claim?
Tuesday, August 26th, 2014

lesb

By Les Buchbinder, Director at Bowen Buchbinder Vilensky Lawyers

26 August 2014

What’s the best way to submit an insurance claim.  In three words: through a lawyer.  Of course, if it’s a straightforward and relatively minor claim – for example, when you discover someone has reversed into your car, denting the passenger door and causing a couple of hundred of dollars worth of damage – there is probably no need or point involving a lawyer.

But for larger and more complex matters, legal advice can make all the difference because the wording of an insurance claim is extremely important.  I want to make it abundantly clear than under no circumstances should an insurer be lied to or deceived.  But getting advice on what information must be included in any claim form submitted to an insurer, and how to word this information, is critically important.

I have been involved in cases where significant disability claims have been paid out, while others, that seemed identical, were not.  The difference in outcomes was likely caused or contributed to by the way the claim form was completed.

If an insurer rejects your claim, that’s not the end of the road.  You can seek legal help to have a letter written to the insurer demanding a full explanation of the basis of rejection of the claim.  The grounds on which the claim has been rejected may be able to be contested and other arguments raised in support of your case.

If the insurer still refuses to accept the claim in part or in whole then, you may then have the option to commence legal action against the insurer for breach of the insurance contract and/or on other grounds, which the insurer will be required to defend.

Whilst current statistics suggest that around 70% of these kinds of disputes are settled during the course of the litigation and mediation process that occurs before going to trial, given the protracted nature of the process and the potentially high legal costs associated with it, you would be well advised to use the services of a fixed price fee lawyer. Doing so provides more peace of mind about costs, and also helps ensure that the momentum of the action is maintained.

In summary, for the quickest and cleanest result, when submitting an important insurance claim, get help from a fixed fee lawyer.

Leave a comment