Life, TPD, Trauma, and Income protection

Hey guys,


Part of setting up my wife and I's smsf I am in the process of getting some life, tpd, trauma and income protection and I will not longer have the default insurance through my industry super fund.


Financial planner endorses onepath and Tal, turned out Tal was the better option so we went with TAL.


Anyway, filled in all the questionaries and they called my wife and I up for a 20 minute interview, asked up medical history, lifestyle questions etc.


Anyway, they have come back and said they are offering to give us cover, with some exclusions:


- no cover for me for accidents or death relating to rockfishing (I told them I do fishing and I do rock fishing)

- no cover for me for my spine, and no cover for my wife for her lumbar unless a medical examiner deems it not to be related to a pre-existing condition (we told them we have had isolated episodes of back pain in the past and got treatment from physio.


I personally think this is a joke. The whole idea of insurance is that it covered you for your situation, you don't get home and contents insurance and get excluded for burglary just because you've been broken into before or because you live in the ghetto, you pay a higher premium accordingly.


My wife is a radiographer and I am an enthusiast in physiotherapy/biomechanics/sports science etc. so we are a bit concerned about the wording of the exclusion. First of all, who hasn't had back pain at some stage of their life? Secondly, a large portion of back and lumbar related conditions or illnesses are the result of degenerative condition through use and abuse over the years, and therefore could be considered "pre-existing"? Thirdly, we all know, if it's muscular skeletal, if it's not your knee, it's going to be your hip, and if it's not your hip, it will be your back that gives way. So why should I pay full price for something that essentially provides me with two thirds of what I need covered?


Seems like TAL are taking the **** and using my disclosure of normal isolated back pain incidents to get out of covering what I think is a very important component of the cover package.


Just wanted to see if anyone had experience with such exclusions and if anyone could give me some tips on what to do? Do I knock back their offer and tell them to where to stick it? Do I accept it and be glad I'm getting covered? Do I look elsewhere for cover or will I be subject to the same exclusions?


Should I go through an insurance broker instead?


Thanks guys, any help greatly appreciated. This whole insurance bs has dragged on for over 3 months and I would like to resolve this issue ASAP.

 

Have you cancelled your previous super fund?
Advice is usually to ensure you have new cover before cancelling the old.
As you have found, pre-existing conditions won't be covered. And as we get older, more and more conditions will occur.
And I hope you wear a life jacket when rock fishing. Far too many drown when washed off the rocks.
Marg

 

If your back pain is bad enough that you would think to mention it then it will ring alarm bells with the underwriters. They will have had the option for exclusion or to slap a loading on it, obviously they went with exclusion.

They don't know you, you are not a person, you are an application form and all they have on you is your medical records and what you tell them.

Go through a broker / fin planner and they may have a better sense of what should and shouldn't be communicated.

"My back aches after a day of gardening" is not relevant, "My back aches in the same place every morning for a couple of hours" probably could be an indication of something expensive to fix.

 

You sign the application form, and declare you have made full disclosure of all medical conditions. Medical conditions are clearly defined, usually anything that warrants a doctor visit other than minor, defined, illnesses. Read the policy disclosure statement.

Of course you can lie, but don't then complain when a future claim is rejected. In the event of any claim, the insurance company will probably require your full medical records.

An ethical insurance broker won't encourage evasions or omissions.

And be careful if you make any further applications. Many ask if you have been refused cover previously, or had exclusions to an offer. Read the fine print.
Marg

 

I hear you!

We pay extra because hubby has osteoarthritis in his knees. We figure we have to, because if he falls and breaks a leg, the argument can be raised that he fell because of the dodgy knees. Or not. Who would know?

But we don't want to run the risk.

We have had an $11K travel claim paid out after cancelling a trip because of a pre-existing medical condition. Declared, thankfully, $100 extra premium. The paperwork required was horrific, ALL of his doctors and specialists had to complete forms.

And yes, hubby spent his working career as an Insurance Broker. Saw far too many people who came unstuck after "forgetting" to mention relevant facts on their application forms, or claimed they "did not think it mattered".
Marg

 

Thanks for the response guys.



I have been very honest and forthcoming with my disclosure. Told them about my shoulder dislocations/subluxations, told them about the time I had a perforation in my bowel and had a chunk of it removed.



I have nothing to hide because I am 32, fit healthy, and have current problems.



The back pain my wife and I have experienced is the same back pain anyone has experienced, just a tight back from fatigue and tight hamstrings/gluts/and hip flexors. We went to the physio to get a bit of a massage, active release techniques and some prehab/rehab advice. I have told my financial planner to communicate this to the underwriter. Let's see what they come back to me with.


In any case, I don’t believe the exclusion is the end of the world, it just makes me feel a bit uneasy that they might be trying to put in a clause that clears them to cover our backs (pun intended)

 

Apologies if it seemed I was suggesting being dishonest, I'm not in any way suggesting that (intent gets lost online sometimes). I was just hoping to point out that a generic "my back is sore from gardening" is not really something they need to know. If your ailment is something that needs to be checked out and diagnosed then it should be communicated.

The OP suggested they had received Chiro, the underwriter really should engage the chiro to find out what the ailment is before slapping an exclusion on it (maybe they did).

 

Me . Never been to physio or chiro .

 

Actually, neither have I.

Yet.....
Marg

 

Maybe call an industry super fund like Australian super for the cost of their insurances.

Most financial planners are limited by their banks as to which products they can sell. Even if they are independently owned their is normally a bank in the background doing "administrative support" for the planner for free in return for having to use a restricted list of investments and products to distribute to their clients.

You might find the planner has a good product to promote but a second opinion is valuable.

 

Thanks for the replies guys. The financial adviser had a chat to the underwriter who said because my wife and I have disclosed we have experience back pain through the years at various locations of the back, and the most recent episode was less than a year ago, they have excluded spine for me and lumbar for my wife. The thing I find funny is my "back pain" was muscular and had nothing to do with my spine.

Anyway, would you guys recommend I get second opinion from other companies and maybe even speak with an insurance broker? Can anyone recommend me an insurance broker?

Thanks guys.