Insurance Claims and Superannuation Disputes

From time to time you may need to resolve a dispute with your insurance company. Disagreements often arise about the amount or damages due from the insurance company arising from an insured event.

Insurance companies are profit making organisations. Part of the insurance companies' role is to ensure that:

  1. Claims are valid. The insurance company often has a different view about what is and is not a valid claim and what claims do and do not fall within the policy.
  2. The amount of money to be paid out by the insurance company is often argued. The insurance industry in Australia is highly regulated.

Each state has laws which dictate which insurance companies can and cannot do when it comes to issuing policies and settling claims. Some key principles are that:

  • An insurance company cannot misrepresent your policy. This means the insurance company cannot knowingly tell you that the policy means something that it doesn’t actually mean. Further the insurance company can't change a policy without informing you in writing ahead of time.
  • The insurance company cannot withhold payment of a claim against one part of your policy in order to force an issue on a claim against another part of your policy.
  • The insurance company must acknowledge and process claims promptly.
  • Insurance companies cannot ask you for unnecessary forms and information in an effort to delay an investigation or payment of a claim.
  • Insurance companies cannot make it a practice to appeal most Court awards to favour their policy holders.
  • An insurance company has to have a good reason to deny or delay a claim and must explain the reason to the policy holder.
  • In most cases the dispute arises because the insurance company claims that:
    1. Premiums are not up to date; or
    2. That the policy doesn’t cover the specific event.

RMB Lawyers are experts in resolving claims by negotiation without recourse to litigation.

As a last resort we will take an insurance company to Court for you. Often once litigation is commenced disputes with insurance companies reach an out of Court settlement following detailed discussions and negotiations between lawyers.

One type of insurance dispute is a dispute over entitlement to superannuation. The most common dispute we see is a dispute over a claim for total and permanent disablement where the insurance company claims that the applicant is not totally and permanently disabled under the relevant trust rules.

We can assist you with regards to lodging a claim with the Superannuation Complaints Tribunal, which is an independent dispute resolution body, which deals with a wide range of superannuation related complaints.

RMB Lawyers helps its clients through that process and in the alternative helps our clients bring a superannuation claim particularly those concerning total and permanent disablement claims to its mediated or litigated end via the Court system. Other claims arise when Banks' insurance arms refuse to pay death or income protection claims. RMB Lawyers are well regarded as being specialist lawyers in resolving these disputes.