Insurer Prevails in Dispute Over Misrepresentation of Mental Health
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.
An individual who failed to disclose her history of mental health and medication use in her life insurance application has lost her dispute with the insurer.
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.
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.
The Australian government has approved a 4.41% increase in health insurance premiums, set to take effect in 2026. This adjustment reflects the rising costs associated with healthcare services and the need to maintain the sustainability of the health insurance sector. - read more
The Australian insurance sector is currently grappling with significant challenges, notably the affordability of premiums for consumers. A recent survey by Gallagher Bassett highlights that premium affordability, cybersecurity, and labour shortages are the top concerns for insurers in 2026. ([insurancenews.com.au](https://www.insurancenews.com.au/daily/industry-reshapes-priorities-amid-price-cost-pressures?utm_source=openai)) - read more
The Australian commercial insurance market is witnessing a notable decline in rates, driven by intensified competition and an increase in insurer capacity. According to reports from global brokers Marsh and Aon, the Pacific region experienced a 12% reduction in commercial insurance rates during the last quarter of 2025, marking the most significant drop since early 2024. ([insurancenews.com.au](https://www.insurancenews.com.au/local/commercial-pricing-tipped-to-stay-soft?utm_source=openai)) - read more
The Australian insurance industry has recently faced a substantial decline in profits, primarily due to a series of severe hailstorms that occurred in October and November 2025. Data from the Australian Prudential Regulation Authority (APRA) reveals that the general insurance sector reported a net profit of $132 million in the December quarter, bringing the annual total to approximately $5.8 billion. This marks a decrease from the $6.8 billion profit recorded in 2024. ([insurancenews.com.au](https://www.insurancenews.com.au/local/industry-profit-sinks-as-hail-hits-home?utm_source=openai)) - read more
Registered building practitioners in New South Wales are facing a critical deadline to secure professional indemnity (PI) insurance by July 1, 2026, in accordance with the Design and Building Practitioners Act 2021. This legislation, which originally set a 2025 enforcement date, has been extended by 12 months to allow the industry additional time for preparation. - read more
Life insurance is a cornerstone of financial planning for Aussie families, offering protection and peace of mind. But what happens when the bustling flow of life brings changes? This is where a life insurance review comes into play. A life insurance review is a thorough analysis of your existing policy to ensure it aligns with your current life circumstances and financial goals. - read more
Life insurance, a contract between an insurer and a policyholder, is designed to provide financial protection to loved ones in the event of the policyholder's death. For parents, this protection takes on a new level of significance. The birth of a child heralds a profound shift in priorities, with a focus on safeguarding the future of one's family. Hence, understanding life insurance options becomes a crucial aspect of responsible parenting. - read more
Life insurance is an essential safety net for families, providing financial security when it's needed the most. As your family grows, the importance of having a well-structured life insurance policy becomes even more critical. In the busy lives we lead today, it’s easy to overlook this crucial aspect of financial planning. However, ensuring your coverage meets your family's evolving needs is vital. - read more
Life insurance is a fundamental component of a robust financial plan, yet its significance is often underestimated. It serves as a safety net, ensuring that your loved ones are financially secure in the event of your absence. Understanding life insurance is the first step towards safeguarding your family’s future. - read more
Being prepared when it comes to life insurance claims can make a world of difference. Proper preparation helps you prevent delays and denials, ensuring that your loved ones receive the financial support promised by your policy without unnecessary hold-ups. By paying attention to the details, you can streamline the claims process, giving you and your family peace of mind during what is already a stressful time. - read more
Start Here !
Apply now for your free Insurance assessment and price comparisons!
Knowledgebase
Proximate Cause: The primary cause of loss in an insurance claim, which sets in motion a chain of events leading to the damage or injury.