Case Studies

Our case notes show how we deal with the many different issues that arise in our case investigations. The case notes aim to provide consumers and participants with guidance as to the approach we are likely to take in a particular type of case or highlight some of the many different ways in which a complaint can be resolved.

Search case studies

Title Year Case summary
Undiagnosed pre-existing medical condition 2020

Paulo knew he was having health problems but didn’t have a diagnosis. Does this still fall within a pre-existing medical condition exclusion?

Covid-19 cancellation 2020

Benedict’s doctor tells him to cancel his trip because the risks posed by Covid-19 are too great, but the insurer says Benedict cancelled the trip because of border closures – is Benedict’s claim valid?

Delay damages business 2020

Andrew’s business was adversely affected by delayed roadworks – was this loss covered by his business interruption cover?

I’m a guarantor not a co-borrower 2020

Sandra agreed to guarantee her daughter’s loan, but when the finance company tried to repossess her car FSCL discovered serious gaps in the application process resulting in Sandra being released from her obligations.

Is COVID-19 a cause or the cause? 2020

COVID-19 led to Japan’s government closing its borders, which led to Mele’s flights being cancelled. Mele’s insurer declined her travel insurance claim, saying the claim was caused by a government interfering with her travel. Was this fair?

Undiagnosed back pain leads to declined claim 2021

Jess purchased a travel insurance policy just after seeing her doctor about some back pain. She did not disclose the back pain, because her doctor had said it was nothing to worry about. Later, the pain was diagnosed as a herniated disk, and Jess had to cancel her trip. Were her cancellation costs covered by her policy?

Sum insured, or most insured? 2020

Jasmine had insured her home for $705,000. But friends had told her she could build a nicer home on her property for just $450,000. Was she over-insured?

One complaint down; one to go 2020

Grace was unhappy with a trustee company’s delays managing her mother’s estate, and their excessive fees. The trustee company agreed to write off $12,000 of fees, and the complaint was settled. But less than a year later, when the estate was finalised, Grace was surprised to receive a new $6,000 invoice.

Pollen theft leads to partially declined claim 2021

Bob’s insurance cover had been reduced following some ambiguous instructions. Later, Bob lost $30,000 of pollen and his insurance claim was partially declined. Was Bob’s insurance adviser responsible?

A strict definition of total permanent disablement 2019

Bopha fell from a stationary ambulance and suffered an injury which left her unable to work as a paramedic. She had $100,000 cover for total, permanent disablement, but her insurer told her that her injury did not amount to total disablement, and that she was only entitled to $5,000. Could this be right?