Labourer Wins Multiple TPD Claims In Spite of Exclusion
Published 29 Nov 2019
Author: Jesicca Yousif
Mr T of Taree formerly worked as an apprentice Panel Beater and subsequently as a General Labourer and Driver. His employment required that he repetitively bend, squat, push and pull machinery and equipment.
In 2015, he sustained a serious injury to his lower back during his employment and was admitted to Hospital. Mr T was able to return to work however in 2016, was diagnosed with L5/S1 Disc Prolapse with discogenic pain. As his employment was predominately in the physical and labour industry, Mr T became permanently unfit for heavy repetitive bending, lifting and twisting or associated periods of uninterrupted sitting or standing or labouring duties. As a result, Mr T ceased all employment in 2016.
Gerard Malouf and Partners were initially engaged to act in respect of Mr T’s workers compensation matter however confirmed Mr T’s potential entitlement for Total and Permanent disablement (TPD) against three separate Superfunds. Mr T confirmed his instruction to proceed with the claims and our Solicitors swiftly began the investigations and preparations of his further three matters.
In spite of his injuries, Mr T’s claims for TPD were complicated by three main factors:
1. Mr T suffered from a previous injury to his knee that led to a knee replacement;
2. Mr T was subsequently diagnosed with morbid obesity and sleep apnoea;
3. Mr T had worked across multiple employers and as a result, had Superannuation and Insurance cover with multiple funds.
Most concerning was a term in the Policy of one Superfund which noted:
“If the Insured Person did not have cover under the Prior Policy before the Commencement Date, they are not entitled to reinstatement if they have applied for, are entitled to, or have been paid a total and permanent disablement benefit or terminal illness benefit from any superannuation fund or life insurance policy”
Mr T had a break in his insurance cover when ceasing with a certain employer. Cover was later reinstated when returning to work with the same employer. During this ‘break’ period, Mr T had obtained insurance cover with two other Funds causing him to fall under this exception rendering him ineligible for a payment with this Fund.
The Fund considered this exclusion during the assessment of Mr T’s claims however with the help of our experienced Solicitors, Gerard Malouf and Partners were able to press past this issue of eligibility and have the claim assessed and approved in full.
Mr T was greatly relieved having received multiple payments:
1. Claim against Superfund 1 for $250, 000.00
2. Claim against Superfund 2 for $80, 000.00
3. With the help of our Solicitors, Mr T is in the process of resolving a claim against Superfund 3 for $325, 000.00
Our team at Gerard Malouf & Partners offer a “no win, no fee” arrangement where our client does not have to pay any fee until their matter is successfully resolved.
If you suffered an injury or illness and become unable to work, contact Gerard Malouf and Partners on 1800-004-878 for a complementary free consultation to assess your legal entitlements and provide you with free advice.