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Life Insurance

The life insurance industry in Australia has come under close and continuing scrutiny in recent times. Consumer agitation, and perceived irregularities in claims handling, have lead to demands for reform, calls for increased powers to be given to the Regulator, and even calls for a Royal Commission into the Industry.

In managing their contested claims portfolios, life insurers are required to be ahead of developments, fast-acting, and must maintain an overview as to the potential public dimension of the management of the individual claim. Life insurers expect their appointed legal advisers to be acquainted with the product, to have the expertise to assess the strengths and weaknesses of the individual case, and to have formulated an overall strategy for the conduct of the matter.

HWL Ebsworth has one of the most significant life insurance practices in Australia and our partners are recognised as amongst the country’s leading practitioners in life insurance claims.

Our life insurance practice operates on a national basis, working together to provide our clients with continuity of service and consistency across all aspects of our service offering, regardless of the jurisdiction in which claims or instructions may originate.

We are familiar with and act for many of Australia’s leading and most reputable life insurers as well as for a number of Australia’s leading superannuation funds and trustee companies.

Life insurers require legal advisers who have extensive exposure to the life insurance industry, and keep abreast of recent developments – be it case law developments, developments with ASIC and APRA, and involvement with industry bodies such as the FSC and ALUCA.

We have advised on and conducted the defence on behalf of clients as well as their associated trustees and third party trustees, of litigated and non-litigated claims concerning Total Permanent Disability (TPD), Total and Temporary Disablement (TTD), and income continuance policy disputes both in the retail and group life area.

We regularly receive instructions to advise on and defend litigation in response to:

  • TPD and TTD claims by life insurers in both retail and group life context;
  • Trauma claims;
  • Income continuance claims in both a retail and group life context; and
  • Death claims.
EXPERIENCE
  • Life insurer: Advising a life insurer on the prospects of unbundling group life insurance cover provided to an insured member, pursuant to section 27A of the Insurance Contracts Act 1984 (Cth), where the insured member non-disclosed /misrepresented after being provided with partial automatic acceptance cover and partial underwritten cover;
  • Former group life policy owner: Advising to the recovery of unpaid premium from the owner of a former group life policy. We attempted to pursue alternative dispute resolution (ADR) but the policy owner was not committed to a compromise settlement and so the action proceeded to final hearing. Our client was successful and recovered all outstanding premiums, accrued interest and its legal costs;
  • Former group life policy owner: Defending proceedings by a former group life policy owner for repayment of premium which was alleged to be overpaid. We recommended to our client to pursue ADR and a commercial approach to the dispute and worked with them in the management of the Court proceedings both formally and informally;
  • Life insurer: Acting in an alleged discrimination complaint by a gay man against our life insurer client and a broker in relation to the wording of an Income Protection Application. We provided advice to our client and appeared on their behalf in the ADT (Equal Opportunity Division). The matter proceeded to mediation. We were able to reach a compromise outcome whereby the discrimination complaints were withdrawn. We also worked with our client to revise the questions in the Income Protection Application; and
  • Life insurer: Advising on a possible systemic breach allegation by the¬†Financial Ombudsman Service (FOS) which arose out of a complaint about a declined claim. Following representations made on our client’s behalf, FOS ultimately withdrew the suggestion that the individual complaint represented a systemic issue.