A woman who was diagnosed with two separate breast cancers will not be covered because the discoveries came days before her life policy’s qualifying period expired.

She was diagnosed with cancer in her right breast on October 5 last year, then in her left breast eight days later. She lodged claims against her critical illness policy, which she bought on July 17. 

TAL Life rejected the claims, noting the policy had a qualifying period of three months for cancer.

In a dispute ruling, the Australian Financial Complaints Authority says the policy included provisions to waive the three-month qualifying period if customers could show they “were insured with [a TAL policy] or another insurer for the same events immediately before your cover starts”.

The complainant said she had cover for cancer through an insurance arrangement provided by her husband’s policy.

She provided a letter from his employer confirming she was covered under its “life, accident, critical illness and medical insurance” between August 2020 and June last year. She also supplied documents showing her husband could add critical illness cover for his spouse, including cover for cancer.

The authority accepts the cancer cover was available to the complainant but is not satisfied she held the cover “immediately before the current policy began”. It also notes the woman did not mention having previous insurance when applying to TAL. 

“There is no information before me about how much critical illness cover the complainant had, if any, through her husband’s employer’s insurance arrangements,” the authority’s ombudsman said. 

“Further, it seems that any cover she did have ended about a month before the current policy began. I am not satisfied there was ‘continuity of cover’ as the complainant suggests.” 

The ombudsman says AFCA sympathises with the claimant given the cancer was diagnosed “very close to the end of the qualifying period”, but says there is no reason it should be waived. 

“The qualifying period is fairly short ... [it] itself is not unfair: all insurance policies have terms which draw a line between claims that will be paid and those that will be rejected,” the ombudsman said. “The application of those terms is not inherently unfair.”

Click here for the ruling.