Insurer Prevails in Dispute Over Misrepresentation of Mental Health

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

The dispute arose when the complainant made a claim on her total and permanent disability (TPD) policy for major depression. In response, MLC (the insurer) decided to amend the policy by adding an exclusion for mental illness, effectively denying the claim.

The insurer argued that it was within its right to add the exclusion because the complainant had misrepresented her mental health history when applying for the policy in March 2015.

Upon reviewing the application form, it was discovered that the complainant failed to disclose her use of anti-depressant medication and provided incorrect answers to questions regarding her mental health.

Misrepresentation of Mental Health

One of the questions on the application form asked whether the complainant had ever experienced or sought advice for anxiety, stress, or sleeplessness. The complainant answered "No," despite having a history of depression and taking medication for it.

The Australian Financial Complaints Authority (AFCA) determined that this answer was a misrepresentation.

The complainant also provided a false answer to another question regarding the use of medications in the last five years. Despite her two-year history of depression and recent medication use, she answered "No" to the question.

AFCA concluded that these misrepresentations were significant in the insurer's decision to add the exclusion for mental illness.

Ruling in Favor of the Insurer

The complainant argued that she was unaware of her depression diagnosis and believed her medication was intended to improve her mood, rather than treat depression.

However, AFCA rejected her explanation, noting that she had sought treatment for "anxiety-related condition" and had taken medication to improve her mood.

AFCA ruled in favor of MLC, stating that the insurer demonstrated the intent to add a mental illness exclusion even without the complainant's misrepresentations. The ombudsman also noted that other insurers would have made similar decisions.

Published:Tuesday, 5th Dec 2023
Author: Paige Estritori

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Insurance News

Clear

Queensland Farmers' Market Threatened with Eviction Over Insurance Dispute

23 Apr 2026: Paige Estritori

In a developing situation in south-east Queensland, the Three Creeks Farm Stall, a popular farmers' market operating in Eileen Hose Park near Gympie, is facing potential eviction due to a dispute over public liability insurance requirements imposed by the Gympie Regional Council. - read more

Record Surge in Insurance Complaints Due to Claim Processing Delays

23 Apr 2026: Paige Estritori

Recent data from the Australian Financial Complaints Authority (AFCA) reveals a significant increase in complaints against insurance companies, with an average of 100 complaints per day. This surge is primarily attributed to delays in processing everyday claims, affecting both home-building and motor vehicle insurance sectors. - read more

Climate Change Contributing to Rising Home Insurance Premiums in Australia

23 Apr 2026: Paige Estritori

Insurance Australia Group (IAG) has released a report indicating that climate change is increasingly influencing the rise in home insurance premiums across Australia. The report highlights that the frequency and severity of extreme weather events, such as severe storms and hailstorms, are escalating, particularly in densely populated regions. - read more

Insuret and ATL Unite to Strengthen Truck Fleet Insurance Services

23 Apr 2026: Paige Estritori

In a significant development for Australia's transport insurance sector, Insuret and ATL have merged to create a unified platform dedicated to fleet and trucking insurance. This strategic consolidation under the Envest underwriting group aims to provide comprehensive coverage and innovative solutions tailored to the evolving needs of the transport industry. - read more

Broker Held Accountable as Insurer Rejects Truck Damage Claim

23 Apr 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled that a broker breached its duty of care, resulting in the denial of a truck damage claim by the insurer. This case underscores the critical importance of brokers thoroughly understanding and communicating policy exclusions to their clients, particularly concerning driver experience requirements. - read more

Click for more Insurance News