A funeral plan insurance policyholder who wants a refund of premiums she has paid over a period of more than 10 years, claiming the insurer failed to “adequately” disclose to her that rates were not capped and were payable until age 90, has lost her dispute.

The woman had acquired the policy from TAL over the phone in February 2004 with a benefit of $6000 and a premium of $25.44 per month.

She says she did not receive the product disclosure statement (PDS) or initial policy schedule that would have provided details of automatic rate adjustments for inflation, premium increases in five-year age bands set according to the next birthday and a waiver after age 90.

TAL was not able to produce a copy of the welcome letter, initial policy schedule or proof of despatch but this does not mean the documents were not sent to the woman in 2004, the Australian Financial Complaints Authority (AFCA) says in its ruling of the dispute.

“The insurer’s obligation is to despatch documents, not to ensure that documents are received,” the ruling says.

“Although not ideal, it is not surprising that the insurer does not have records to prove dispatch of documents in 2004.”

AFCA notes also that the woman, who was represented by her children in the dispute, did acknowledge receiving the PDS on the day she was on the phone with TAL to acquire the policy.

The call was recorded and a summary of the exchange provided by TAL stated the woman confirmed she had received the funeral plan brochure with a key features statement.

The ombudsman also points out the woman made calls to the insurer on several occasions including in 2012, 2017 and 2018 where she was told that she could reduce her premiums by reducing her benefit sum or turning off the automatic inflation.

“Unfortunately, the complainant terminated each of the telephone calls,” the ruling says. “It would not be fair to require the insurer to refund premiums when the insurer disclosed the policy terms and the complainant had the benefit of insurance cover in the event of her death.”

Click here for the ruling.