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Insurer wins claim dispute after lip filler goes wrong

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Suncorp has won a claim dispute with a cosmetic clinic whose client undertook legal proceedings after injectable fillers triggered an adverse reaction.

Fillers were injected into the eye area and lips of a woman who visited the clinic on April 24 2018.

Two days later, the woman saw her doctor after suffering discomfort. She then went to hospital as an infection had spread to her nostril, she was bruised and swollen on the right side of her lip and was taking ibuprofen for pain relief. She messaged the clinic detailing these events.

The clinic bought a 12-month Healthcare Establishments Medical Malpractice Policy from a Suncorp brand which started on August 1 2018, around three months after the woman received the fillers.

On December 9 2019 - more than four months after the clinic’s policy expired - the cosmetic and wellness clinic was served with legal proceedings for the filler reaction incident. Suncorp was notified on Christmas Eve 2019.

Suncorp declined indemnity as the claim was not made or notified during the policy period.

The Australian Financial Complaints Authority (AFCA) agreed the policy required claims to be made and notified within the period of insurance. Due to the timeframe of events, Suncorp was entitled to refuse indemnity, AFCA ruled.

“There is no information to show (the client) made any demands on the complainant during the period of insurance,” AFCA said. “The communication was before and after the period of the insurance.”

AFCA said the “effect of the policy is to allow the insurer to refuse payment of a claim due to the failure of the complainant to notify in writing of a claim made within the period of insurance.”

Suncorp said the clinic should have flagged the incident after the client messaged that she was receiving medical attention, though the clinic said there was no indication legal action was a likely scenario.

The policy stated that “the Insuring Clause responds to claims … notified to the insurer during the policy period.”

“The facts that you must decide to notify are those which might give rise to a claim against you,” it said.

“Such notification must be given as soon as reasonably practicable after you become aware of the facts and prior to the policy period expiring. If you give written notification of facts the policy will respond even though a claim arising from those facts is made against you after the policy has expired.”

See the full ruling here.