A major insurer has backdated its decision to update its outdated definitions of severe rheumatoid arthritis and heart attack, meaning consumers who had their claim rejected previously may get a more favourable result upon review.
MLC Life Insurance’s arthritis definition would be backdated to apply from 1 January, 2014 on MLC Insurance Critical Illness Plus and Personal Protection Portfolio Critical Illness Plus policies, while the revised heart attack stance would apply from 10 September, 2012.
Outdated medical definitions had been under scrutiny for some time. The Banking Royal Commission revealed some insurers operated with now inaccurate terms and the Australian Securities and Investments Commission (ASIC) investigated CommInsure in 2017 for using outdated definition to deny claims, amongst other issues.
According to law firm Slater and Gordon’s state practice group leader, Sarah Snowden, MLC Life Insurance insureds could now have their claim reviewed, warning that they should act quickly as there were strict time limits on reviewing decisions in some parts of Australia.
“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,” Snowden said.
“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.”
MLC Life Insurance’s definitions were updated to comply with the Financial Services Council (FSC) Life Insurance Code of Practice.
