Persistence and perseverance eventually pay off in a real battle of a
claim.
A couple of years ago, a long-term client who was a truck driver, took
out a Personal Accident and Illness policy with Westralian Insurance.
What happened
Early one night at home, he fell down his stairs and injured his
leg. At the time, he didn’t think he had done anything serious. The pain was extreme, however he assumed he
just had a minor injury.
He had dinner and a beer, but with the pain becoming increasingly worse,
his wife decided to drive him to the Emergency Department of his local
hospital.
Shortly after, scans revealed that he had in fact broken his leg and
would need at least three months off work to recover.
On admission to the hospital, the doctor had noted he could smell
alcohol on our client’s breath, so the Personal Accident insurer immediately
declined the claim. We argued that
alcohol was consumed AFTER the accident and the hospital had never undertaken a
blood test or breathalyser to prove he was intoxicated.
The insurer once again declined the claim.
We then had the matter referred to the insurers Internal Disputes Facility
and their management also declined the claim.
The outcome
Not happy with this decision, we involved AFCA (Australian Financial
Complaints Authority) who in turned agreed with us and forced the insurer to pay
the claim.
The client was extremely happy that he had an insurance broker on his
side, armed with knowledge and the facts, in order to push the claim decline
further and further, until all options had been exhausted.
The insurer agreed to pay out the claim and we are happy to report that
our client has made a full recovery and is back working again.
This true story is another demonstration of our commitment to our
clients, and an example of why you should engage a professional insurance
broker.
Call Westralian Insurance today on (08) 9302 1388, or visit
www.westralianinsurance.com.au
