QBE INSURANCE DIRTY TRICKS

[Eagleview]

This mainly pertains to Australian sole trader businesses but I would check with your insurance company wherever you may be .

I was involved in an accident on the 5th of February 2010 and broke my right knee . I was unable to work so I made a claim against my sickness and accident insurance only to be refused . I was refused because they , QBE Insurance said I had made no income for the previous year because my tax return said nil tax to pay . QBE has taken that as no income , no income means I have not lost anything so they don't need to pay up .
I sent them a copy of my tax for the previous year and also a profit and loss statement . Because I had bought some new , quite expensive machinery in the previous years which my accountant claimed the depreciation against my taxable income and also claimed my business costs , my business then showed no profit for the year . The tax man had no problem with that but QBE did .
This means that EVERY sole trader business that is not showing a profit above their costs is effectively uninsured . We have always been advised that if you are not a PTY LTD Company and cannot get Workers Compensation insurance on yourself that you MUST get Personal Accident Insurance to relieve the Prime Contractor for any accident you may have . This is a total rort by this insurer , they are quite happy to take the premiums from you but when you make a claim , out comes the small print . Small print but always big words and written in a fashion that the lay person can't understand . I would say that MOST sole trader businesses at the moment in this recession are not making a profit but merely trying to keep their heads above water until better times come along . These people will find they are all uninsured in the event of an accident . I have only been back at work a few weeks and I'm still having a hard time walking , I have had little income since February and this has really been a tough time . And now , because of the lack of income and the fact that QBE didn't pay up , my earnings for this year will definitely be down , so if I get hurt again I still wont be covered .

 

[dmccarty]

If this had happened in my state I would suggest talking with the Insurance Commission at a minimum. I think the State Attorney and the Commerce Department have jurisdiction as well.

Later,
Dan

 

[Chuck52]

If this had happened in my state I would suggest talking with the Insurance Commission at a minimum. I think the State Attorney and the Commerce Department have jurisdiction as well.

Later,
Dan

Hopefully, there's an equivalent in Australia.

Chuck

 

[Eagleview]

Thanks for your input chaps , I have lodged a complaint with the Financial Ombudsman and am waiting for a reply .

QBE Insurance has now sent me a letter saying they will not renew my Accident Insurance Policy because of my severe injury and the likely hood of it being an ongoing problem . It's great isn't it ? I get hurt whilst insured with them , they are still taking the premiums out of my account to this day , they refuse to pay up and now they sack me .

It gets worse , my major Prime Contractor has just informed me they can no longer use my services as they say "I'm virtually uninsured" .

The problem we face is that we don't really know if we are running at a loss until our yearly tax is done and all the depreciation on current machinery is worked out . There are unknowns as well , like machinery you may buy later in the year that will affect your income as well . Also lack of work because of bad weather and being in the middle of a recession doesn't help . Even if we do find out , what are we supposed to do ? Take a part time job at a Pizza Hut to lift our income so our insurance becomes valid ?

Very underhanded and deceitful , I hope they never refer to themselves as Aussies .

 

[dmccarty]

It sure does not sound correct that is for sure. I see how they are playing the tax game on this to their advantage which is not right.

If I understand our Disability laws it is possible that one could not get disability here if you had no income for a period of years. I think it is three years. So if a mother stops working to stay at home for five years until the child goes to school she will not have any income and will not pay into Social Security. If the mother drops the kid off at school one day and then gets in a car accident which leaves her disabled she will not be able to get disability payments since she has had no income in years. Yet she paid into the system for years. But only the last few years count.

Hopefully someone will tell me I am wrong.

Later,
Dan

 

[tallyho8]

Hopefully someone will tell me I am wrong.

Later,
Dan

You're wrong.

 

[jpm]

as been said before,time to lawer up.it's unforunate that insurance plays the game all the time

 

[dmccarty]

You're wrong.

So explain to me why I am wrong.

Later,
Dan

 

[smstonypoint]

So explain to me why I am wrong.

Later,
Dan

Dan,

Based on the SSA link below, you are correct in general. However, the "recent work test" and "duration of work" vary with age.

Disability Benefits

Steve

 

[dmccarty]

One can loose one's ability get to SS Disability payments even after being in the work force for years.

How one looses the coverage depends on age.

I could not believe it when I read this years ago. I was reading because a friend has ALS and was going out on SS Disability. I carry extra disability insurance which he was not able to get because he had a pre existing condition. My Duh moment was when I realized that my disability insurance pays so that I get 2/3's of my month pay check. BUT....

The BUT is that the policy pays ON top of SS Disability. The policy does not pay me 2/3 of my current pay. It makes up the difference between the SS Disability payment and 2/3s of my pay. I don't get 2/3s of my pay check AND the SS Disability.

I thought I was well covered.

I am not but I am covered better than most.

Later,
Dan

 

[tallyho8]

So explain to me why I am wrong.
Later,
Dan

Because it is not 3 years, it is 5 years. Unfortunately, I learned this through experience.

My son, at age 40, became disabled 5 years ago. He had worked for 20 years as an electrical engineer and networking computers among other jobs. When he slowed down due to his illness they fired him and he lost his health insurance and was not able to see the right doctors to get diagnosed properly.

He applied for disability and was turned down on appeal after appeal because the doctors at the cheap clinics could not find out what was wrong with him and attributed it to laziness. It took 4 years to get to his final appeal. After 3 years the doctors finally diagnosed him with primary progressive multiple sclerosis which is the worst kind. He is unable to even get out of bed many days and is unable to walk without assistance and can not speak well enough to argue his case.

When his final appeal came up 4 years later they ruled against him denying him his 4 years of back pay. They stated that although he could prove he is completely disabled with multiple sclerosis now that he could not prove he had it 4 years ago when he applied for disability.

He was able to reapply for disability and they approved him rather quickly just before the 5 year deadline.

Of course I had been providing financial assistance to his family for these 4 1/2 years out of my retirement fund hoping to get paid back after he got his 4 years of back pay which he never got so my retirement fund is much smaller now.

Trying not to sound political, it is awful hard to believe how our government treats people who are hard honest workers all their lives, faithfully paying into social security and then if they become completely disabled, making them jump through hoops that they are not capable of jumping through in order to get their disability.

Yes my son should have saved more but it is few people who have enough saved to supplement 4 or 5 years of lost income and he was completely bankrupted and today has nothing except a meager monthly check that will never provide for his family's future. I just hope I leave enough when I die to pay for my grandsons college.

 

[coffeeman]

Because it is not 3 years, it is 5 years. Unfortunately, I learned this through experience.

My son, at age 40, became disabled 5 years ago. He had worked for 20 years as an electrical engineer and networking computers among other jobs. When he slowed down due to his illness they fired him and he lost his health insurance and was not able to see the right doctors to get diagnosed properly.

He applied for disability and was turned down on appeal after appeal because the doctors at the cheap clinics could not find out what was wrong with him and attributed it to laziness. It took 4 years to get to his final appeal. After 3 years the doctors finally diagnosed him with primary progressive multiple sclerosis which is the worst kind. He is unable to even get out of bed many days and is unable to walk without assistance and can not speak well enough to argue his case.

When his final appeal came up 4 years later they ruled against him denying him his 4 years of back pay. They stated that although he could prove he is completely disabled with multiple sclerosis now that he could not prove he had it 4 years ago when he applied for disability.

He was able to reapply for disability and they approved him rather quickly just before the 5 year deadline.

Of course I had been providing financial assistance to his family for these 4 1/2 years out of my retirement fund hoping to get paid back after he got his 4 years of back pay which he never got so my retirement fund is much smaller now.

Trying not to sound political, it is awful hard to believe how our government treats people who are hard honest workers all their lives, faithfully paying into social security and then if they become completely disabled, making them jump through hoops that they are not capable of jumping through in order to get their disability.

Yes my son should have saved more but it is few people who have enough saved to supplement 4 or 5 years of lost income and he was completely bankrupted and today has nothing except a meager monthly check that will never provide for his family's future. I just hope I leave enough when I die to pay for my grandsons college.

Many wonder why some folks "lawyer up" at the get go. As much as we like to make jokes about them, the end result is we need lawers to protect us from tyranny.

Cheers Coffeeman

 

[dmccarty]

Because it is not 3 years, it is 5 years. Unfortunately, I learned this through experience.

My son, at age 40, became disabled 5 years ago. He had worked for 20 years as an electrical engineer and networking computers among other jobs. When he slowed down due to his illness they fired him and he lost his health insurance and was not able to see the right doctors to get diagnosed properly.

In your sons case he was in a different age group. Depending on the age group you can loose the benefit in three years. From the SS website, "For example, if you become disabled at age 27, you would need credit for 3 years of work (12 credits) out of the past 6 years (between ages 21 and 27)." There are three age groups, the one just mentioned and one for people under the age of 24 and for people over 31.

Your son's case seems like he was in the 31+ age group, "Age 31 or older--In general, you need to have the number of work credits shown in the chart below. Unless you are blind, you must have earned at least 20 of the credits in the 10 years immediately before you became disabled."

The "In general" statement worries me a bit.....

The point of my post was to show that one can loose one's disability benefits in the US. And one can. I think that will shock people. It sure shocked me.

Let me give people some free advice learned the hard way.

If you are sick and you cannot get diagnosed correctly with your local doctor, get to a hospital that is at a teaching University that has a good reputation. They are certainly not perfect but you will have a much better chance than with other doctors. My family is constantly at the doctors for one thing or another. At this point we basically go to Duke and UNC.

One thing they constantly put on the table is that if we have problem's paying there are programs to help. I don't know how good those programs are since we thankfully have not had to use them but they are there.

Later,
Dan

 

[tallyho8]

If you are sick and you cannot get diagnosed correctly with your local doctor, get to a hospital that is at a teaching University that has a good reputation. They are certainly not perfect but you will have a much better chance than with other doctors. My family is constantly at the doctors for one thing or another. At this point we basically go to Duke and UNC.

One thing they constantly put on the table is that if we have problem's paying there are programs to help. I don't know how good those programs are since we thankfully have not had to use them but they are there.

Later,
Dan

The worst part about it was my son got sick right before Katrina. He started going to teaching University doctors who couldn't diagnose his problem before Katrina. After Katrina, half the hospitals in southeast Louisiana were shut down and the other half too crowded to handle anything except emergencies for years.

With all the problems we had after Katrina and as busy as we are were doing repairs, plus the financial bind, it was impossible to try to go to out-of state-hospitals. Even today our major hospitals in New Orleans are still shut down and not rebuilt yet.

Three years after Katrina, they had to schedule his cat-scan 6 months in advance to diagnose his illness.

I know everyone is tired of hearing about Katrina and how bad it was after, but believe me, I lived through Betsy, Camille and many other major hurricanes and none of them had even 1% of the cataclysmic aftereffects that we suffered after 2005.

 

[dave1949]

Tallyho8 & Dan, Your posts have been real eye openers and informative. Thanks for sharing.
Dave.

 

[nap61]

Iron horse,
There is a large legal difference between income and profit. In the U.S. there are various governmental agencies that regulate insurance companies. I am sure that there is at least one agency which has oversight in your case. "Keep on trucking". If you run into the brick wall, get a lawyer (Solisitor/Barrister).

Norm

 

[nap61]

Tallyho,
The difference between Betsy, Camille, and the other hurricanes we endured in S.E. Louisiana and Katrina is that those hurricanes "only" devastated portions of the community. There was resources left to support and rebuild the effected areas. Katrina wiped out the entire city and surrounding Parishes.

Norm

 

[Eagleview]

Iron horse,
There is a large legal difference between income and profit.

Norm

That is the second time Ive heard that , it is only with your post it has stuck . I did in fact insure my income , I'm sure the policy is for income . So why are they talking about profit ?

Is it just to confuse a layperson who drives a tractor for a living for a reason ?

On edit , no mention of Profit in their booklet .

 

[smstonypoint]

There is a large legal difference between income and profit.

It's more than just a legal difference -- in Economics 101 we learn that firms try to maximize profits [total revenue less total costs] rather than total revenue (gross income).

Steve