A builder who received income protection payouts then made promotional videos for social media and was filmed playing tennis has lost a complaint before the financial services ombudsman.

The man’s claims were fraudulent because he misrepresented the severity of his condition in 2023 to receive a full IP benefit, the Australian Financial Complaints Authority has ruled.

Insurer TAL was entitled to refuse the claims and to avoid the policies.

The self-employed builder took out two IP policies, in 2011 and 2013, and claimed under both in October 2019, stating he suffered neuropathic pain. Benefits began that month.

TAL began investigating in 2022 when the man’s promotional videos appeared, and it denied the claims in June last year, cancelling the policies the following month.

The claimant complained to AFCA, saying he had medical evidence of total disablement.

But AFCA says while the man’s condition may have stopped him doing full-time building work, he may have been able to do this or other work for more than 10 hours a week.

TAL provided surveillance videos from 2023 showing the claimant playing tennis, working in his backyard for four hours, using an excavator, using an axe, breaking up cabinetry, loading building supplies into his vehicle and renovating his home. 

It also produced evidence of him participating in an event that involved climbing 77 flights of stairs. 

The man submitted progress reports throughout the claim and doctors’ reports following telehealth consultations in 2023. He had a list of more than 90 medical appointments and reports from a pain specialist, neurologist and psychologist. 

He also had evidence that another insurer had accepted his claim for a total and permanent disability benefit. 

TAL argued it was irrelevant whether the man was disabled when he had fraudulently misrepresented his condition. The ombudsman accepts this “since fraud includes the exaggeration of an otherwise legitimate claim to gain a financial advantage”. 

Read the ruling here.