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Case Overview
- The plaintiff, who previously worked as a community development officer and counsellor, was involved in a serious car accident in 2006.
- The Judge ruled the insurer was incorrect in both elements of its reasoning for rejecting the claim.
- The claimant received $90,000 from their TPD Claim.
INSURER FAILED TO PAY OUT
The exact wording of TPD policies varies from insurer to insurer, but many rely on the same principles and criteria for approving a payout. Claimants must first have been unable to return to work for a specified time period, which was six months in this particular case.
Furthermore, after this timeframe elapses, the insurer must generally be satisfied the individual is unable to work again in a role for which they are reasonably qualified by education, training or experience.
The insurer in this case rejected the claim on two fronts:
The medical evidence did not support the conclusion the plaintiff was unable to work because of injury or illness when she ceased employment in January 2018.
The evidence available did not suggest the plaintiff would never be able to work again as of July 2018 – six months from the date of disablement.
The judge ruled the insurer was incorrect in both elements of its reasoning for rejecting the claim. He argued there was significant medical evidence to show the plaintiff was suffering serious mental health problems at the time she ceased work, including drug prescriptions for her depression and anxiety.
The judge also noted the terms of the policy did not require the woman to show she wouldn’t ever return to work by the assessment date, only that she was unable to go back to her job at that time. This is a much lower threshold and warranted the $90,000 TPD payout.
Ultimately, insurance policies are designed to ensure people are able to access financial support when unforeseen circumstances strike. But insurers don’t always have claimants’ best interests at heart, which is why you should always obtain expert legal advice on whether or not to accept a decision.
Please contact a no-win, no-fee lawyer at Gerard Malouf & Partners Superannuation Lawyers to find out if you are entitled to life insurance benefits.
The Result
The TPD claim was approved for $90,000.
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