Case Overview
Our client is a resident of Castle Hill who was formally a business development manager working in a high stress office environment until a motor vehicle accident caused her significant injuries to the head and neck. She was hospitalised and had surgery. As a result she had permanent symptoms of migraine and constant neck pain which also caused her loss of concentration and fatigue.
As a result our client did not return to work. After around eighteen (18) months of treatment and surgery, our client was certified ‘fit’ for work and a return to work programme was arranged. It was intended to commence after her final discectomy which was unfortunately conducted negligently and as a result suffered further injuries and never returned to work from that date.
Our Approach
Our client had contacted Gerard Malouf & Partners to conduct a medical negligence claim and she conducted her claim for a TPD insurance herself. This policy was rejected on the basis that she did not fit the definition of the TPD policy. They alleged that at the time of the motor vehicle accident, she was not ill as to be completely unable to work as evidenced by the returned to work certification. However, when she did become unable to work as a result of the medical negligence, she had not been working pursuant to the definition of active employment under the policy which in this case is defined as working more than fifteen (15) hours per week for the period of six (6) months prior to the date of disablement.
At that time our client retained Gerard Malouf & Partners to prosecute the TPD claim. Our solicitors immediately took action, identifying that the hinge of the insurer’s case is on the narrow interpretation of the policy and optimism prior to the medical negligence, which a matter that cannot be held against our client. We commenced proceedings against the insurer at the Supreme Court of New South Wales. However, this matter was not without a degree of risk if heard before a judge. Once the evidence was prepared, based on our client’s instructions.
After a period of approximately twelve (12) months through the court process the matter was resolved a month out of hearing, for approximately 75% of the insured benefit as a matter of compromise. Our client was greatly relieved at the result and able to receive a decent sum of money in hand from the policy.
Total and Permanent Disablement policies are not injury claims but contractual disputes that may appear to defy common reason. They are highly complex as the wording of the policies are written to supposedly account for all possible scenarios. Our solicitors at Gerard Malouf & Partners have experienced and expertise in conducting Total and Permanent Disablement and other insurance contract disputes at the Supreme Court of New South Wales and other forums. Should you have a rejected TPD claim or is otherwise interested in seeking advice to make a claim, please do not hesitate to contact Gerard Malouf & Partners to speak to one of our solicitors for a free consultation.
The Result
The claim was approved in around 12 months after lodgement for 75% of the insured benefit.
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