Widow handles insurance provider MetLife after it turns down late hubby’s claims

Amanda Dunn believed her family was covered if the worst occurred.

Her hubby, Roger, had a congenital heart disease and after surgical treatment as an infant, he went on to lead a complete and active life.But the danger

was always there.

So, like hundreds of thousands of Australians, they secured a life insurance policy after having their two children.

“That was the entire factor we secured the insurance coverage– to be covered for your home and for our future, and for the women’ future in case something did happen,” Ms Dunn informed the ABC.

They bought joint MetLife policies through ALI Group when they refinanced the mortgage on their house.

The couple disclosed Mr Dunn’s heart disease and, for nearly a decade, the couple paid their premiums thinking they were completely covered.

But in 2013, Mr Dunn established pulmonary high blood pressure, his health rapidly weakened and he could not work.

Facing significant monetary challenge, the household sent a claim for overall permanent special needs (TPD).

They were stunned when they got a letter from MetLife in 2015, stating Mr Dunn did not get approved for a payment.

“It was turned down based on grounds that he wasn’t sick enough to declare for it, so we went back and forth to the medical professional who filled out all the medical forms and he still wasn’t sick enough to claim for TPD,” Ms Dunn said.

“He was really ill; he had to stroll with oxygen and he couldn’t shower since all his veins were rather protruded, and they would bleed so he would have to cover them up in bandages.

“He couldn’t work certainly, and he didn’t have much of a lifestyle.”

MetLife then turned down another claim on the basis Mr Dunn’s condition was pre-existing, in spite of specific recommendations from a cardiologist that lung hypertension was a “separate problem” that was not linked to his congenital heart illness.

With Mr Dunn unable to work, Ms Dunn had to continue her job as a teacher to generate money, rather than stay at home and take care of him.

“I was extremely upset because I believe our household was under enough pressure. I had to work more and have less family time with the girls,” Ms Dunn said.

” [Our household] were placing on that adult role as well, of being the other moms and dad, and taking care of [Roger] while I was still working and trying to keep everything going.”

Days before Mr Dunn passed away, MetLife once again rejected their claim for TPD.

“He was tired. I think the telephone call on the Monday that stated the TPD had actually been declined, I believe that was it,” Ms Dunn said.

“I believe he ‘d given up hope and he could not fight any longer, and he was so weak.

“The last thing he said to me was ‘thank you for being such a beautiful other half and mother to my kids’. And I type of knew then that was it.”

Second claim declined by MetLife

Mr Dunn died in healthcare facility following a series of medical problems leading to kidney failure and heart attack.

Then the Dunn household suffered yet another blow: MetLife declined a different claim for life insurance.

The business said under its policy, pulmonary high blood pressure was considered a pre-existing condition and therefore might not be declared upon.

Ms Dunn has actually vowed to continue combating for her hubby’s life insurance coverage payout.

“I know it would have been important to Roger due to the fact that I have actually got life insurance, and I ‘d anticipate that to be paid out to my ladies if something did occur to me,” she stated.

In a statement to the ABC, MetLife said it could not comment particularly on the Dunns’ case.

Nevertheless, the business said customers required to think about whether the terms and conditions of their policy were suitable for their needs.

“A pre-existing condition exemption associates with a condition the customer had struggled with previous to the beginning of the insurance. The customer would be eligible for other conditions covered by the policy, which are not pre-existing,” the business stated.

“Each claim is evaluated on its merit and the decision to decline a claim is thought about extremely thoroughly, based on the offered evidence.”

Ms Dunn rejected support she was entitled to anticipate: attorney

Lawyer Paula Shelton from Adviceline Injury Attorney has handled Ms Dunn’s case.

“Regrettably I believe Amanda’s situation actually epitomises what has actually failed with life insurance coverage claims,” Ms Shelton informed the ABC.

“She and Roger secured this policy, preparing that they would be covered if the worst occurs– I imply that’s what insurance is for.

“They divulged the condition that existed. Sadly Roger suffered an unusual condition– a brand-new condition– yet bad Amanda has actually been left without the kind of support she was entitled to anticipate.”

Ms Shelton stated the Dunns should not have actually been offered a policy that did not suit their needs.

“I would hope that the royal commission would check out all those situations, particularly in regard of pre-existing conditions and denial of policies based upon them,” Ms Shelton said.

“Definitely simply accepting the client’s money was not suitable in this situation.

“We know that it’s a complicated matter to examine a lung and a heart condition– there were a variety of things that were offered to the insurer to do.

“They might have got an authority from Roger and got info from his basic specialist, and his professional about his condition,” Ms Shelton stated.

Customer groups desire modification

Ms Dunn’s choice to share her story comes as the insurance coverage market is set to be grilled as part of the next round of the Royal Commission into Misbehavior in the Banking, Superannuation and Financial Solutions Industry.

Customer groups have actually long been requiring changes to life insurance.

Ahead of the next round of royal commission hearings, the business regulator, the Australian Securities and Investments Commission (ASIC), launched a report knocking the market for its high-pressure sales tactics.ASIC’s report

also said sales practices frequently led to “poor consumer results”, with clients struggling to understand intricate products.

Alexandra Kelly from the Financial Rights Legal Centre said customers typically had a bad understanding of key exemptions.

“Some of the basic changes we want to see is a disclosure of what the customer has in fact acquired,” she informed the ABC.

“Current item disclosure declarations can run up to 100 pages, have great deals of cross-referencing and include products that they can’t even claim on.

“So we ‘d like to see tailored info directed at the consumer.”

First published