Former Police Officer Wins $226K TPD Benefit
Published 01 Dec 2019
Author: Jesicca Yousif
Ms H was a former Police Officer with NSW Police for over 20 years. She was forced to cease work in 2017 as a result of physical injuries sustained during the course of her employment over many years.
Circumstances of the Disability
Ms H first suffered an injury to her back in 2003 during her employment. This was later exacerbated in 2007 whilst performing emergency services. Ms H was able to resume duties in 2008 after engaging in conservative forms of treatment, including physiotherapy and hydrotherapy, followed by surgery.
In or around 2016, Ms H again re-exacerbated her back condition. This was not attributed to a specific event but rather a gradual onset of symptoms. At this point, Ms H was performing full duties. She ceased all work in 2017.
Despite participation in all recommended forms of treatment, Ms H continued to experience high levels of pain. Her functional capacity had been impaired to the point where she required assistance performing activities of daily living including dressing, bathing, toileting, mobility and domestic duties.
As a result, Ms H engaged Gerard Malouf and Partners to pursue a claim against her Superfund for an insured benefit.
Lodgement of the Claim
Investigations promptly came underway and the claim was lodged in July 2018.
However, the superfund/insurer continued to insist on additional documents. These requests became unreasonable as substantial information had been produced to allow the proper assessment of the claim. After providing sufficient time and issuing letters of demand, proceedings were commenced in the Supreme Court in January 2019 following the ongoing failure to make a decision.
To Ms H’s great relief, the claim resolved in the early stages of litigation for the full benefit of over $226, 000. Gerard Malouf & Partners are presently in the process of recovering some of the legal costs against the trustee/insurer which was incurred by Ms H in having to commence proceedings as a result of the failure for a determination to be made in a timely manner.
Unfortunately, there are circumstances where the insurer fails to determine a claim in a timely manner and causes delay by requesting documents/reports that are not reasonably necessary to its assessment of the claim. In such instances, it becomes necessary to take a more aggressive approach in order to progress the assessment of a claim.
Our firm is recognised as an Australian leader in its areas of law with offices throughout the east coast of Australia specialising in Sydney, country New South Wales, South East Queensland and Victoria.
If you have had to cease work as a result of injury or illness, contact Gerard Malouf & Partners today and see how one of our expert solicitors can help you get the benefit you may be entitled to.