The woman argued her involvement in family matters and proximity to her ex-spouse, with whom she shares four children, warranted the classification of a "close relative." However, AFCA's ombudsman ruled that her situation did not fit within the policy's strict definition, which encompasses direct blood, marital, or de-facto connections.
Despite acknowledging the familial ties, the ombudsman emphasized the policy's clear distinction of close relatives, explicitly listing ties such as spouse, children, and siblings. Notably, the complainant's absence from her ex-husband's 'marriages' section on the death certificate further validated the insurer's position to deny the claim.
While the ruling recognized the complainant's valid actions given her emotional and familial connections, the terms outlined by the policy were highlighted as definitive and comprehensive, excluding her specific relationship.
The decision underscores the importance of understanding policy definitions and the possible limitations faced when seeking coverage for non-traditional family structures within the insurance landscape.
