Mr W was previously employed as a Police Officer. His role involved but was not limited to general policing duties, emergency calls, first response officer, investigations, physical altercations, walking and driving.
In February 2014, Mr W sustained an injury, during the course of his employment, to his lower back accompanied by neurological compromise following a slip and fall accident whilst he was exiting a police vehicle to make an arrest. As a result of the accident, Mr W was required to undergo a lumbar laminectomy and Rhizolysis followed by a spinal fusion in July 2017.
Mr W approached Gerard Malouf & Partners in respect of a Workers Compensation claim however our Solicitors wasted no time in recognising a potential further claim in the form of Total and Permanent Disablement through Mr W’s superannuation insurance.
Our expert Solicitors undertook various investigations to confirm insurance cover and eligibility to claim. This was then followed by the detailed preparation of the claim prior to lodgement for assessment. Ensuring a claim is appropriately prepared and submitted can help place the insurer in a position to determine the claim and avoid any unnecessary delay. In circumstances where there is delay despite all appropriate documents being provided and reasonable compliance with the insurers requests then the insurer’s position may be taken to be unreasonable and in breach of its various duties. This may then give rise to a cause of action and grounds for litigation. Having a solicitor involved during this process can help safeguard your rights.
In the case of Mr W, various obstacles arose as a result of the conduct of the Superannuation fund and its insurer. Namely, there was a substantial delay by the Superannuation in referring the claim to its insurer for assessment. Once referred, the insurer continued to insist on documentation that either had already been produced or that was not reasonably necessary for the assessment of the claim.
To avoid any further unnecessary delay and to bypass the insurers time wasting tactics, Mr W instructed Gerard Malouf and Partners to commence legal proceedings. A Statement of Claim is used to initiate proceedings in the Court. It details the facts and circumstances of the claim together with the relief being claimed. A Statement of Claim was prepared and served on the Fund prior to being formally filed with the Court. This provided a grace period of 14 days for a decision to be reached else proceedings would be commenced.
This prompted the insurer to determine Mr W’s claim. A decision to admit the claim in full was communicated within 5 days of being served with the pre-filed Statement of Claim. To Mr W’s great relief, he received his full insured benefit of $104, 000 shortly thereafter.
Often the superannuation fund and/or insurer may engage in strategies that cause delay to the appropriate progression of a claim. This includes, but is not limited to:
– Request for documentation/information already supplied
– Request for documentation/information reasonably available
– Failure to progress the claim in a timely manner
It is imperative to get in touch with the right expert to file the case for total permanent disability claims to ensure that your claim progresses swiftly and that your rights are protected.
To discuss any potential entitlements you may have, please contact our firm for a free consultation on 1800 004 878.
