Can the insurer refuse a claim because I was drink driving?
- 01.07.2026
I have a back condition and my income protection insurer says I am able to do some kind of work, so they stopped my benefit. My doctor says I am unfit for my normal job. How do insurers decide this? Nobody has given me a straight answer and I want to understand where I actually stand.
The outcome depends on how your policy defines disability. Many policies define total disability as being unable to perform your own occupation, whereas others use an any occupation test, which is stricter and considers whether you could do other work for which you are suited by education, training or experience. Check which definition applies, as well as whether it changes after an initial period. The insurer must consider medical evidence fairly, and disputes often turn on medical opinions, so ask your specialist for a detailed report about your capacity. Request the insurer's reasons and any surveillance or vocational reports in writing. If the insurer's decision is unreasonable, complain through the internal process, and then the dispute resolution scheme, and consider getting advice from an insurance lawyer.
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