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I am trying to make an income protection insurance claim. I…

I am trying to...

I am trying to make an income protection insurance claim. I submitted the claim in August 2017. After 7 phone calls and numerous follow ups, I am still being the given the brush off. What can I do from here?

Lawyer's Assistant: What state/territory are you in? It matters because laws vary by location.

Hi Pearl, I am in Victoria.

Lawyer's Assistant: What steps have you taken so far?

I have a thick file of medical records. I have completed the application claim form. I have a doctors certification to stop work due to my back being injured.I have given AIA access to all my medical records and other requirements. I have provided all my financial records, including 2014,15,16 Tax returns showing financial losses to the cent.

Lawyer's Assistant: Anything else you want the lawyer to know before I connect you?

No, thanks Pearl

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Answered in 8 minutes by:
4/4/2018
John Melis
John Melis, Lawyer
Category: Australia Law
Satisfied Customers: 3,562
Experience: Principal Lawyer at Legal AU Pty Ltd
Verified
Hi, my name is***** solicitor in Melbourne. Thank you for using Just Answer, and I will answer your question today and ask various questions to narrow the issues in your post raised.
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I am sorry to hear the difficulty you are experiencing.You will have a claim under the Australian Consumer Law based on the facts that you have described. The legislative Act that applies is the Competition and Consumer Act 2010, Schedule 2.All sellers warrant that goods or service are acceptable for their use/service.Goods:a. Goods must be of acceptable qualityb. Goods must be fit for purposec. Goods must match their descriptiond. Goods must match any sample or model.Services:a. Must be rendered with due care and skillb. Services must be fit for the specified purpose.c. Services must be provided within a reasonable time.Seller has several options they can provided where goods or services have not meet the requisite standard. The seller can either repair, replace, refund, compensation, and cancel the entire contract.What you need to do is to write a formal complaint to the company. This complaint needs to be in a chronological order detailing what is the issue and what action you have taken to try and rectify the matter.The chronological order need to be be numbered with points 1, 2, 3, etc. with each point being a separate item.The complaint needs to have detailed what you need fixed and for a time limit of a minimum of 7 days to apply.The complaint then needs to be sent to the dispute resolutions department. Make sure you keep a copy for yourself.
Preferably send the complaint by email.
If you do not receive a reply within 7 days issue a follow up complaint to the first complaint issued.If no response is received then it is time to commence an action in QCAT.

You can lodge this claim directly on their website. The key element of the claim is the points claim that details the matter, This application point will need a little time to prepare the facts, and I recommend that you download the application first, review, fill it out, and then when you are ready lodge the same onlineYou may also have a claim of misleading conduct by the seller, under section 18 of the Australian Consumer Law. In general, misleading someone may include conduct ranging from lying to them, to making false or inaccurate claims, to creating a false impression, to leading them to a wrong conclusion, to omitting important information. Importantly, it is not necessary to establish that the trader intended to mislead or deceive. A person or corporation may have engaged in conduct that was misleading or deceptive even if they have acted honestly and reasonably. Silence may constitute misleading or deceptive conduct, but this will depend on the circumstances of the case.The contractor cannot rely on a disclaimer or exclusion clause to protect themselves from misleading or deceptive conduct. However, the fine print will still be considered.Would you like to try this option of the complaint first.
You have a legal right to protect your interests in this important situation.
If you need any further information please let me know.You can come back to this post any time to ask questions and there will be no further charges to you.Don’t forget to rate me 5 stars as this supports me helping the community, and your important questions.Have I answered your question today ?
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QCAT should be VCAT, Victorian Civil and Administrative Tribunal.
John Melis
John Melis, Lawyer
Category: Australia Law
Satisfied Customers: 3,562
Experience: Principal Lawyer at Legal AU Pty Ltd
Verified
John Melis and 87 other Australia Law Specialists are ready to help you
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Customer reply replied 4 months ago
Hi John,Thank -you for this great advice. I have rung today expecting the usual runaround and they are saying recommend to pay today.
The advisor attached to my claim has said that they will be contacting me in two hours with an amount.
If the offered amount is significantly less than claimed, am I able to refuse and ask for more, or can I accept and fight for more in the future?
thanks
Nick

yes you can refuse if you are not agreeable to the amount.

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Customer reply replied 4 months ago
What if I am desperate for money?

then you can negotiate to a point that is comfortable to you.

you are in control of the process.

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Customer reply replied 4 months ago
That is great John, I will write when they call if that is OK?

yes that is ok

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I have extended a special offer if you need to talk on the phone too.

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Customer reply replied 4 months ago
Thanks John I will take you up on it after they call
Sure
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Customer reply replied 4 months ago
Hi John,
Thanks for your follow up.
To fill you in, I have received an offer which is substantially less than I expected. I was very disappointed and said so.
I put in a call to my accountant and advisor who had organised the insurance in 2006. As a self employed carpenter My incomes were 2014: $54623,then 2015 $ 17867 after my injury. I did not get a proper doctors appointment till 5/6/2015, this date I was trying to claim from, after 6 months off work before this date. The insurance company is prepared to accept oct 2016 as a start date which means they will pay a rate based on the year before wage of 17,000. Very unfair giving me 4000 for 2016 and 8000 for 2017, and 2100 per month until 5 years if injury persists.
My advisor has contacted AIA on my behalf explaining I had an agreed value policy, and wasn't subject to this assessment of income. He included a 2009 year of $64000. The agreed value amount is 3600 per month for 5 years with no change to other amounts. This is the rate I have been paying my premiums at for 12 years, totalling over $30,000 to date.
Should I accept this new offer, even though it doesn't compensate me for the 2015 year where I earn't the least?
Many thanks John
Nick
Customer reply replied 4 months ago
Bit confusing I know but you should get the gist, I pay 308.94 per month to get a disability income of 3691.08 per month for 5 years after injury.
you can try that
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The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

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