The Australian Financial Complaints Authority (AFCA) has ruled a TAL customer who holds an income protection policy can only claim for a few months of benefit payment, rejecting his arguments that he was entitled to a bigger payout.

The customer, who runs a financial planning business, says he has had depression since August 2009, affecting his ability to work. He wants his benefit payment to start from August 2009.

But TAL rejected his claim, saying he has not met the terms of the policy.

AFCA in its ruling upheld the recommendations made by the case manager who had looked into the complaint, saying they have been made based on the right reasons and evidence provided by both parties.

The complainant took his dispute to AFCA in April 2011 after the insurer rejected his claim seeking a benefit payment from August 2009 to date.

AFCA says the complainant has not provided “reliable” evidence to support his arguments that he was suffering from depression but did not know it at that time.

“While depression is not as obvious as other medical conditions which show external signs, I do not accept that a person can be so depressed that they are unable to work and be unaware of it,” AFCA says in its ruling.

“In 2009, depression was a widely known condition in the community.”

AFCA notes also that the complainant was setting up a life insurance business in 2009, having sold his financial advice planning firm, and is aware that depression is a medical condition that can lead to insurance claims.

“The symptoms of depression which is severe enough to interfere with work are readily apparent to a sufferer,” AFCA said. “In these circumstances, it is inconceivable that he would be so depressed that he could not work and yet also so unaware of his condition that he did not seek medical help.

“There is no medical evidence which says that depression itself caused the complainant to be unaware of depression.”

However, AFCA says TAL must pay the complainant income protection benefits for the period from May 14 2011 to August 9 2011 and interest from August 9 2011 as he had met the definition of loss of income as defined in the policy.

It says the complainant provided medical evidence including clinical notes that showed he was diagnosed with the condition during that period.

AFCA also ordered TAL to pay $500 to the complainant for poor customer service and inconvenience he suffered at that time.

Click here for the ruling.