maui
1st Mar 2009, 06:26
Much has been said on other threads WRT the relative merits of the various policies. To date little has been published in the way of analysis. FWIW the following is a summary of some of the benefits payable and the comparitive ways claims are dealt with, by the contending policies. Numbering and headings are taken from one of the policies and applied to the relevant parts of the other contender. Maui's comments are included.
Assuming a Nominated Capital Benefit (NCB) of $500,000
7.1 Permanent Total Disablement (Loss of Licence)
By Accident (subject to exclusions) And By general Illness Brand A 100% Brand B 100%
By substance Illness and By Undiagnosed Illness Brand A 50,000 Brand B under 5 years membership 120,000 (18 payments x 6666.66) 5-7 years membership 210,000 (36 payments x 5833.33) More than 7 years membership 255,000 (45 payments x 5666.66)7.2 Temporary Total Disablement (Loss of Licence)
By Accident
Brand A 10,000 /month x 12 months (120,000)
Brand B 7,500/ month x 12 months then 5,000/month x 48 months (330,000)
By General Illness
Brand A Same as for accident
Brand B Same as for accident
By substance Illness and By Undiagnosed Illness
Brand A 1,000 /mth x 12 months (12,000)
Brand B under 5 years membership 120,000 (18 payments x 6666.66)
5-7 years membership 210,000 (36 payments x 5833.33)
More than 7 years membership 255,000 (45 payments x 5666.66)
Death
By Accident
Brand A 100,000
Brand B 700,000 ( Balance of NCB plus an additional 100,000 – 200,000 dependant on length of membership.)
By General Illness
Brand A Nil
Brand B 700,000 ( Balance of NCB plus an additional 100,000 – 200,000 dependant on length of membership.)
Rebates Upon cessation of cover
Brand A Nil
Brand B After 20 years membership And no claims
All contributions(principal only, no interest)
Brand A Policy Highlights
1.7 General Insurance Code of Practice
The Insurance Industry has developed a General Insurance Code Of Practice. This aims to raise the standards of practice and service in the Insurance Industry and it includes the following………..
7.5 Dispute Resolution
This insurance is not required to comply with The Insurance Council of Australia’s General Insurance Code of Practice
Comment: Why even mention a Code of Practice if they don’t feel bound by it?
Brand B no such protestations and those making decisions are voted in and out by their peers.
2.4 Duties Of The Insured
You or the insured person must advise the Underwriters of any changes in the medical standards of the licence issuing authority or any other authority having jurisdiction over the Licence(s)/Certificates, including governmental authority. Failure of You or The Insured Person to comply with this condition will give the underwriters the right to refuse to pay any claim under insured Events 7.1 or 7.2 after the effective date of such changes in medical standards whether or not the claim was in any way related to such changes.
Comment: The onus is on the insured to keep up with legislative and policy changes of CASA. Not even CASA can do that successfully.
Brand B keeps itself appraised of these changes. No action required on the part of the insured.
4.0 Special Limitations And Conditions In Respect Of Certain Insured Events
4.1 All Insured Event 7.1 Permanent Total Disablement (loss of Licence)
No payment will be made should an Insured Person die within twelve (12) months of the issuance of the long term unfitness assessment or permanent revocation by the licence issuing authority. The underwriters shall not be obliged to settle any claim until one hundred and eighty (180) days after the Date of Loss or the date an Insured person makes a claim under this insurance, whichever occurs last nor before all enquiries relating to the claim have been completed by the underwriters. The Underwriters may at their option settle the claim in yearly instalments……………. Comment: Die within 12 months and if a payment has been made they can seek restitution from your estate.
Scheduling of payments is contingent upon the Underwriters completion of enquiries.
At their discretion the Underwriters can make payments annually.
There are no timetables.
Brand B covers death in an appropriate manner, as detailed above.
4.3 Insured Event 7.1.4., Permanent Total Disablement (Loss of Licence) by Undiagnosed Illness
Compensation is payable at the entire discretion of the Underwriters, without any right of recourse of You or The Insured Person contained herein or to any court having jurisdiction.
Comment: If you don’t agree with their decisions you have no right of recourse. I doubt that such a clause is lawful, as you cannot legally waive a statutory right or entitlementand I believe Insured consumers have statutory rights and entitlementsunder consumer legislation.
Brand B has a Dispute resolution process that involves outside arbitration, and ultimately the laws of the State of Victoria.
5.7 Permanent Total Disablement (Loss of Licence)
b) the inability of the Insured Person to obtain any similar Licence(s)/Certificate(s) anywhere in the world within a period of sixty (60) months from the date of the issuance of the unfitness assessment or revocation
Comment: Self explanatory, but if another state changes its medical standard to allow your disability, you have no claim. It should be noted that ICAO medical standards are recommendations only.
Brand B benefits relate specifically to the Australian Class 1 Medical certificate and “approved” overseas equivalents.
7.2 Termination
The insurance will terminate and cease to have effect upon the Insured Person:-
b) ceasing to be gainfully employed in the capacity for which he holds the Licence(s)/Certificate(s) held at the inception date of this Insurance stated in Item 5 of the Schedule
Comment: Lose you employment and you lose your ability to insure you licence at the same time.
Brand B give a 3 year period of grace.
7.3 Capital Sum Insured Restriction
In order to recover the full benefits payable under this Insurance, You or The Insured Person must have notified the Underwriters of any other loss of licences insurance and the existence of that other insurance must have been noted and accepted by the Underwriters before any claim arises. If no such prior notification has been given, this Insurance is deemed to be surplus to all other valid and collectable insurances. Any payment under these circumstances will only be the difference, if any, between the Capital Sum Insured Restriction, as stated above, and all other insurance.
Comment: If the underwriters choose not to recognise additional insurance (they are not obliged to accept) then they will sit at the top of the tree when it comes to payment. If you reach THEIR max before you get up to them, you get nothing.
Brand B is paid exclusive of any other insurances or indemnities.
8 Claims Procedure
Upon the happening of an Insured Event, the Insured Person and/or his Legal Personal Representatives must:
Make a claim by notifying the entity named in Item 4 of the Schedule in writing by registered mail as soon as possible and in any event not later than thirty (30) days after the date of death or the date of unfitness as a result of sustaining an Accident or the manifestation of illness.
Comment: No notification within 30 days, no payment.
Brand B allows 90 days.
Assuming a Nominated Capital Benefit (NCB) of $500,000
7.1 Permanent Total Disablement (Loss of Licence)
By Accident (subject to exclusions) And By general Illness Brand A 100% Brand B 100%
By substance Illness and By Undiagnosed Illness Brand A 50,000 Brand B under 5 years membership 120,000 (18 payments x 6666.66) 5-7 years membership 210,000 (36 payments x 5833.33) More than 7 years membership 255,000 (45 payments x 5666.66)7.2 Temporary Total Disablement (Loss of Licence)
By Accident
Brand A 10,000 /month x 12 months (120,000)
Brand B 7,500/ month x 12 months then 5,000/month x 48 months (330,000)
By General Illness
Brand A Same as for accident
Brand B Same as for accident
By substance Illness and By Undiagnosed Illness
Brand A 1,000 /mth x 12 months (12,000)
Brand B under 5 years membership 120,000 (18 payments x 6666.66)
5-7 years membership 210,000 (36 payments x 5833.33)
More than 7 years membership 255,000 (45 payments x 5666.66)
Death
By Accident
Brand A 100,000
Brand B 700,000 ( Balance of NCB plus an additional 100,000 – 200,000 dependant on length of membership.)
By General Illness
Brand A Nil
Brand B 700,000 ( Balance of NCB plus an additional 100,000 – 200,000 dependant on length of membership.)
Rebates Upon cessation of cover
Brand A Nil
Brand B After 20 years membership And no claims
All contributions(principal only, no interest)
Brand A Policy Highlights
1.7 General Insurance Code of Practice
The Insurance Industry has developed a General Insurance Code Of Practice. This aims to raise the standards of practice and service in the Insurance Industry and it includes the following………..
7.5 Dispute Resolution
This insurance is not required to comply with The Insurance Council of Australia’s General Insurance Code of Practice
Comment: Why even mention a Code of Practice if they don’t feel bound by it?
Brand B no such protestations and those making decisions are voted in and out by their peers.
2.4 Duties Of The Insured
You or the insured person must advise the Underwriters of any changes in the medical standards of the licence issuing authority or any other authority having jurisdiction over the Licence(s)/Certificates, including governmental authority. Failure of You or The Insured Person to comply with this condition will give the underwriters the right to refuse to pay any claim under insured Events 7.1 or 7.2 after the effective date of such changes in medical standards whether or not the claim was in any way related to such changes.
Comment: The onus is on the insured to keep up with legislative and policy changes of CASA. Not even CASA can do that successfully.
Brand B keeps itself appraised of these changes. No action required on the part of the insured.
4.0 Special Limitations And Conditions In Respect Of Certain Insured Events
4.1 All Insured Event 7.1 Permanent Total Disablement (loss of Licence)
No payment will be made should an Insured Person die within twelve (12) months of the issuance of the long term unfitness assessment or permanent revocation by the licence issuing authority. The underwriters shall not be obliged to settle any claim until one hundred and eighty (180) days after the Date of Loss or the date an Insured person makes a claim under this insurance, whichever occurs last nor before all enquiries relating to the claim have been completed by the underwriters. The Underwriters may at their option settle the claim in yearly instalments……………. Comment: Die within 12 months and if a payment has been made they can seek restitution from your estate.
Scheduling of payments is contingent upon the Underwriters completion of enquiries.
At their discretion the Underwriters can make payments annually.
There are no timetables.
Brand B covers death in an appropriate manner, as detailed above.
4.3 Insured Event 7.1.4., Permanent Total Disablement (Loss of Licence) by Undiagnosed Illness
Compensation is payable at the entire discretion of the Underwriters, without any right of recourse of You or The Insured Person contained herein or to any court having jurisdiction.
Comment: If you don’t agree with their decisions you have no right of recourse. I doubt that such a clause is lawful, as you cannot legally waive a statutory right or entitlementand I believe Insured consumers have statutory rights and entitlementsunder consumer legislation.
Brand B has a Dispute resolution process that involves outside arbitration, and ultimately the laws of the State of Victoria.
5.7 Permanent Total Disablement (Loss of Licence)
b) the inability of the Insured Person to obtain any similar Licence(s)/Certificate(s) anywhere in the world within a period of sixty (60) months from the date of the issuance of the unfitness assessment or revocation
Comment: Self explanatory, but if another state changes its medical standard to allow your disability, you have no claim. It should be noted that ICAO medical standards are recommendations only.
Brand B benefits relate specifically to the Australian Class 1 Medical certificate and “approved” overseas equivalents.
7.2 Termination
The insurance will terminate and cease to have effect upon the Insured Person:-
b) ceasing to be gainfully employed in the capacity for which he holds the Licence(s)/Certificate(s) held at the inception date of this Insurance stated in Item 5 of the Schedule
Comment: Lose you employment and you lose your ability to insure you licence at the same time.
Brand B give a 3 year period of grace.
7.3 Capital Sum Insured Restriction
In order to recover the full benefits payable under this Insurance, You or The Insured Person must have notified the Underwriters of any other loss of licences insurance and the existence of that other insurance must have been noted and accepted by the Underwriters before any claim arises. If no such prior notification has been given, this Insurance is deemed to be surplus to all other valid and collectable insurances. Any payment under these circumstances will only be the difference, if any, between the Capital Sum Insured Restriction, as stated above, and all other insurance.
Comment: If the underwriters choose not to recognise additional insurance (they are not obliged to accept) then they will sit at the top of the tree when it comes to payment. If you reach THEIR max before you get up to them, you get nothing.
Brand B is paid exclusive of any other insurances or indemnities.
8 Claims Procedure
Upon the happening of an Insured Event, the Insured Person and/or his Legal Personal Representatives must:
Make a claim by notifying the entity named in Item 4 of the Schedule in writing by registered mail as soon as possible and in any event not later than thirty (30) days after the date of death or the date of unfitness as a result of sustaining an Accident or the manifestation of illness.
Comment: No notification within 30 days, no payment.
Brand B allows 90 days.