AIA has won a summary judgment application seeking recovery of income protection benefits paid under fraudulent claims, and a declaration that its cancellation of the policy was valid. In a final blow, the insured was ordered to pay AIA’s legal costs of the application on a full indemnity lump sum basis in the sum of $110,000.00.
In AIA Australia Ltd v Richards (No 3) [2017] FCA 1069, Vincent Brian Richards was an anaesthetic nurse who made a number of claims for income protection benefits from 28 March 2003 to 10 October 2016. In the claim forms, Mr Richards made statements including that he was unable to perform all the duties of his usual occupation in the claim period; he had not performed any of the usual duties of his occupation during the claim period; and he “Never!” expected to resume his usual duties. Several of the claim forms recorded addresses in Sweden, and the final claim form recorded an address in Riga, Latvia. Towards the end of 2015, AIA became suspicious of the claims. AIA embarked upon a meticulous investigation process including Facebook and internet searches. Those searches uncovered a Facebook profile for “Vinny Richards” to which was uploaded a business card for “Holistic Health Riga”. “Holistic Health” had a website on which it was stated that the business was “new in Riga offering an Holistic approach to your health and wellbeing” and had premises in Sweden and Latvia. The website also contained a link to a profile on another website called “Healthcare Volunteer” in the name of “Vinny Richards”. In that profile, it was stated that “I am an Australian living in Latvia & Sweden ... I trained as a nurse … I also have a clinic in Riga Latvia where I practice Acupuncture. In the clinic we also make Facial Rejuvenation with Botulium Injections and Dermal Fillers”. On each of the “Holistic Health” and “Healthcare Volunteer” websites, there was a photograph uploaded which was the same as the Facebook profile photograph for “Vinny Richards”. On the basis of these searches, it was considered appropriate to conduct surveillance. Investigators in Sweden and Latvia booked and received treatment from “Vinny” in both business premises (with some investigators returning on a number of occasions for repeat treatments), and recorded the treatments using the camera on their mobile phones. During those treatments, “Vinny” made a number of statements including that he “had some hip pain due to a motorcycle accident” and that he “comes from Australia”. On 19 October 2016, AIA sent Mr Richards two letters. The first declined Mr Richards’ claim dated 10 October 2016, and provided detailed reasons. The second was a cancellation letter, with the cancellation stated to take effect in 28 days. On that same day, Mr Richards responded to those letters. Included in the response was the following statement: “Yes the information is true. I am doing some acupuncture treatments”. On 27 November 2016, Mr Richards wrote to the Federal Court of Australia in lieu of appearing at the first case management hearing of the proceeding. Included in that letter were the following statements: “So I would like to explain the reason why I did not inform AIA of my intentions. The reason is that I knew if I told them they would cause me problems and maybe threaten to stop the benefit” and “It was a stupid thing to do as to lie on my documents to AIA but I really felt I had to take the chance …” On the basis of all of the above, Allsop CJ was satisfied that Mr Richards knowingly made false statements in making the claims from 5 February 2016, and stated that the clarity of the evidence was sufficient to satisfy him to the Briginshaw standard. His Honour entered judgment for AIA in respect of payments and investigation expenses incurred after 5 February 2016. In respect of the cancellation issue, his Honour noted a previous decision of the Supreme Court of New South Wales in which it was held that an insurer could not cancel a policy prospectively by reason of a fraudulent claim (Alexander Raymond Walton v The Colonial Mutual Life Assurance Society Ltd [2004] NSWSC 616). Allsop CJ expressly rejected this proposition. Accordingly, in addition to the potential of this case to deter future fraudulent conduct, it has also set a new precedent for the contention that an insurer may prospectively cancel a policy if a fraudulent claim has been made. Published on October 24, 2017 by Lana Collaris
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Published by Maria Longland · 12 October · Another Happy Client - TPD Lodgement to Payment less than 4 months 👊 Today I was so pleased to make that life-changing call to my client to advise them their TPD claim with MLC has been accepted. There were tears of joy, as this has given some light at the end of the tunnel for a most beautiful young family whose father has been diagnosed with a severe case of RA at such a young age. I know it doesn't take away his condition or the immense pain that this client is suffering but it will help them financially, giving them options for the future. This is why I do what I do #RheumatoidArthritis #RA #TPDCLAIM #payout #THANKYOUMLC#mlcTPD #HAPPYCLIENT #Riskassist Got a policy with Q Super? Need to make a claim? Just had success for a client who had been trying for over 12 months to get a TPD payout, within 2 months of coming to @riskassist we have had a claim accepted, far beyond what he expected #happy #happyclient #insurance #insuranceclaim#success #TPDclaim #payout #qsuper#personalinsurance #riskinsurance#allinadayswork #tal
Terminal Illness - A morbid subject? YES...
But a necessary one; Many people find themselves in this situation without even being aware that they can make a claim under their Life insurance policy or Life insurance within their superfund. Most insurers have increased their life expectancy from 12 months to 24 months making it easier to meet the terminal illness definitions. Here is a link to an article about one such Insurer, c/o MoneyManagement -http://www.moneymanagement.com.au/news/insurance-property/asteron-adopts-24-months-terminal-illness-definition#.WOMyM-v3gmA.facebook Contact me to discuss a potential claim |
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