Former Federal Agent wins $295k Payout for TPD Claim after Court Proceedings Commenced
Published 30 Nov 2019
Author: Jesicca Yousif
Our client, Mr B of Bondi, was previously employed as a Federal Agent with the Australian Government. His usual duties included deployment overseas and high-level security.
During a skills training course in 2015, an instructor fell heavily on Mr B’s wrist, causing an acute dislocation of a joint in his right wrist. He underwent surgery and was later required to wear a wrist brace. Unfortunately, he developed post-operative neuritis. After injections and further surgery to his elbow, Mr B developed an ongoing impairment to his neck and right upper limb. He underwent a fourth surgery to his left shoulder was later diagnosed with a secondary psychological condition. Mr B became unfit to return to work and his employment was subsequently terminated.
Mr B sought the services of Gerard Malouf and Partners in respect of a worker’s compensation claim and to investigate a possible claim for Total and Permanent Disablement. Our solicitors were able to quickly assess Mr B’s claim and determine that he had a viable claim for TPD through his superannuation fund in the sum of $400, 000 at the date of injury.
A claim was swiftly prepared by GMP and lodged for assessment however the superfund trustee and its insurer failed to issue a decision in a timely manner. The insurer eventually formed the view that there was evidence indicating that Mr B could return to alternate work.
Unfortunately, TPD claims are not always straightforward. In the case where a determination is unreasonable or where there has been a breach in the insurer’s duty towards the member, particularly in failing to determine a claim without reasonable cause, then it may become necessary to commence court proceedings.
In Mr B’s case, GMP ligated the matter to press the claim forward alleging the trustee and insurer had breached its duties towards Mr B. During the proceedings, Mr B underwent an employability assessment and assessment by an occupational physician at the request of the insurer, who opined Mr B may be able to resume work within his education, training and experience. GMP submitted further evidence in support of Mr B’s claim however there were several conflicting reports regarding Mr B’s capacity to work. Mr B’s claim was further complicated by other factors including an increase in insurance cover sometime prior to his injury, subsequent return to work following the initial injury and a pre-existing psychological condition which Mr B had disclosed at the time of taking out the policy.
Despite the evidence against our client, our Solicitors pressed forward and were able to resolve the matte, for a substantial portion of the insured benefit by way of informal negotiations without the need to go to Court. Mr B was extremely relieved and grateful that the matter had finally come to a resolution despite various obstacles in the matter.
Our expert Solicitors aim to handle each claim efficiently and protect the rights of our client. GMP are mindful of the importance of the client’s position and take every measure to achieve the maximum result.
Contact Gerard Malouf and Partners on 1800 004 878 for a free consultation to determinate your legal rights and provide you with expert advice.