Length: 2000 words

Task: Students will be required to identify and apply the relevant principles and rules of Australian insurance law to the resolution of a hypothetical problem.

Criteria:
• Precise articulation of relevant legal issues
• Evaluation and application of relevant legal rules to problem scenario
• Comparing and contrasting of contending arguments in order to critique intended outcomes
• Formulation of clear and effectively articulated advice to clients

INSURANCE LAW: PROBLEM SOLVING ASSIGNMENT

PLEASE CLEARLY INDICATE WHICH QUESTION YOU ARE ANSWERING.

QUESTION 1 (In Australian insurance law NSW)

Kevin Abbott, 45, operates awell-established and profitable bricklaying business based in Tweed Heads in Northern New South Wales. He is generally fit and healthy as he spends a lot of time working outdoorsand is a keen surfer. He has a family history of skin cancer – with one of his uncles recently having undergone melanoma treatment therapy. On the15thofJanuary 2014, based on the urging of his wife Therese, he consults his local GP Dr John Smith about some sun spots on his left shoulder. Dr Smith refers Kevin to see a specialist dermatologist Dr Mary Green on the 29thof January2014. After noting Kevin’s family history of skin cancer, Dr Green carefully examines Kevin and freezesthe sun spots on his shoulder with liquid nitrogen. Dr Green also points out some sun spots on Kevin’s left forearm which she recommends he watch carefully and come back to her promptly if he notices any changes. She also urges him to wear SPF 50+ sunscreen and to keep covered when out in the sun, as she rates him as being at very high risk of developing skin cancer, and warns him that melanomas can develop and spread quite rapidly. Dr Green makes detailed notes of her observations for Kevin’s file. However Kevin does not follow Dr Green’s advice, muttering to a friend that he thinks her advice is “a bit over the top.”

On the 20th of March2014, Kevinis introduced by a friend at a social function to Julian Gillard, who is a financial advisor with XYZ Bank, one of Australia’s largest diversified financial services providers. XYZ holds an Australian Financial Services Licence and an Australian Credit License issued by ASIC. Kevin mentions to Julian that he is interested in looking into options for consolidating his credit cards – which he uses quite often to fund the overseas holidays he takes with his wife and family several times a year. He agrees to meet with Julian to discuss further as he wants to reduce his bank fees and interest payments.

On the 23rd of March 2014, Kevin meets with Julian at the local XYZ branch office. After chatting with Julian about his existing credit cards, he completes an online application with Kevin for an XYZ credit card, which is approved shortly afterwards. Julian then mentions to Kevin“By the way, here at XYZ we also offer life and terminal illness cover. It’s always a good thing to have. Our premiums are very competitive, and we pay all valid claims. The application process only takes a few minutes – would you be interested in applying?”Kevin replies that he would like to apply.

Julian then commences an online application form for the “XYZ Life and Terminal Illness Cover Policy”, which he shows to Kevin on his office computer screen as he completes it. As Julian enters Kevin’s details he also discusses the latest cricket results. The online proposal form asks a range of questions about medical conditions. Question 19 asks “Have you ever consulted a dermatologist for sun damage to your skin?” Kevin states to Julian “Oh yeah,the other month I saw a dermatologist to have some sun spots checked.”

In response to Question 19, Julian ticks “Yes” – which then prompts a further question about the date and outcome of the consultation. Julian asks Kevin “What was the result of that consult?” Kevin replies “The doctor froze some spots of my right shoulder.” Julian replies “Ok, sounds pretty standard, nothing too serious then?” Kevin replies “No seemed all good – she told me to keep a look out for any changes.” Julian replies “Ok that sounds pretty standard to me, I think we’ll tick the ‘No further treatment required’ option on that question.” Kevin nods in agreement.

After completing the online application form (which includes a duty of disclosure notification in accordance with Schedules 1 and 2 of the Insurance Contracts Regulations 1985 (Cth), Julian prints it off for Kevin to sign, and then puts it in the mail to XYZInsurance. Julian also provides Kevin with a Product Disclosure Statement on the XYZ Policyand XYZ’s Financial Services Guide. He jokes to Kevin “If you have trouble getting to sleep, these should help!”

Julian also prints off a Statement of Advice from the XYZ template which documents the advice he has provided to Kevin about life and terminal illness insurance, and they then continue talking about the cricket.

On the 30th of March 2014, Kevin receives notification that XYZ Insurance has accepted his application for the Life and Terminal Illness Cover Policy.

On the 25th of February 2015, being concerned about theirregular size of some sun spots on his left forearm, Kevin consults Dr Green. Dr Green investigates and does some tests. She concludes thatthe sun spots on Kevin’s left forearm are malignant melanomas, and that the cancerous cells have started to spread around his left forearm. She advises that his condition appears to be terminal and that his prospects of a full recovery are slim. Dr Green arranges for Kevin to commence immediate anti-cancer treatments – which will be very expensive and require him to cease his bricklaying business.

On the 10th of March 2015, Kevin submits a claim to XYZ Insurance to access his benefits under the Life and Terminal Illness Cover Policy. After receiving Kevin’s claim, XYZ requests and obtains full details of Kevin’s medical records from Dr Smith and Dr Green. After reviewing these records, XYZ’s claims manager Bob Fraser arranges a meeting with Pauline Purple who managesXYZ’s life underwriting department which decided to issue the policy to Kevin. Pauline carefully reviews Dr Green’s file notes “Well this certainly changes things … had we known about these comments I doubt we would have issued the policy!”. Pauline’s views are confirmed by Malcolm Hawke, a senior underwriter with XYZ who is given the file with Dr Green’s file notes.

Based on the facts above, advise Kevin:

1. Whether he would be likely to be successful in claiming on the XYZ Insurance policy; and
2. Whether he would be able to take any actions against Julian Gillard
Length: 2000 words

Task: Students will be required to identify and apply the relevant principles and rules of Australian insurance law to the resolution of a hypothetical problem.

Criteria:
• Precise articulation of relevant legal issues
• Evaluation and application of relevant legal rules to problem scenario
• Comparing and contrasting of contending arguments in order to critique intended outcomes
• Formulation of clear and effectively articulated advice to clients