Jin* and his wife Mei* had life and trauma insurance. In 2018, Jin made a trauma insurance claim after being diagnosed with stage 4 colon cancer at age 31. The insurer said it was avoiding the policy, because Jin had not disclosed 2 material facts: a colonoscopy he had when he was 13, which may have found a polyp, and a nutritional anaemia diagnosis during an immigration medical in 2013. Jin said his only memory of the colonoscopy was being told there was “nothing to worry about”, and he recalled being told he had “low blood” in 2013 because of his diet. Jin died shortly before the complaint was referred to the IFSO Scheme.
There were limited facts available about the colonoscopy, and no follow-up. The insurer could not prove Jin knew he had suffered “any disease or disorder of the gastrointestinal tract or bowel” as he was asked on the insurance application.
The case manager concluded the anaemia diagnosis was material, because 3 prudent underwriters advised they would have requested follow-up tests and offered different policy terms.
The case manager asked if the insurer would consider settling the complaint on the reduced cover that would have been provided, if the anaemia had been disclosed. The insurer agreed, and Mei received half the life benefit: $95,664.
Complaint settled
*Names have been changed.