TPD Not “At Work” Declined Claim Resolved by GMP
Published 29 Nov 2017
Our client was Ms K from Dubbo. She was formerly a prison officer working for the NSW Department of Corrections. Our client had suffered a work injury in early 2000 and as a result had physical restrictions and psychological injury. As a result, our client became unable to work, and ceasing work in mid-2000. As part of the workers compensation which was conducted by another law firm, Ms K attempted to return to work on light duties in early 2010 which was ultimately unsuccessful.
After her workers compensation concluded Ms K decided to pursue a claim for total and permanent disablement (TPD) insurance which was held in her superannuation fund. The insurer declined her claim arguing that she was not working sufficiently and already afflicted from working at the time she stopped all work in early 2010 – when attending return to work duties. The insurer denied that Ms K had become unable to work around the time of the initial work injury.
The other lawyers advised our client that there was no basis to proceed. She subsequently sought advice from our firm and we advised her that there are reasonable prospects. It can be argued that Ms K had become unable to work as a result of the initial injury and that the return to work in 2010s was not work for the purposes of the policy. We took conduct of the case and commenced proceedings at the Supreme Court.
The insurer hired lawyers who attempted to argue there was no evidence sufficient to show that Ms K became unable to work because of the initial injury but rather because of the later deteriorations – when our client was on light duties. However our firm made strong representations to the contrary drawing attention to the finding in the Workers Compensation Case. As a result of these representations, negotiations were had prior to Hearing and the insurer was willing to resolve this case for 80% of the policy amount.
Our client is exceptionally relieved at the resolution and very happy at our firm’s conduct of this case, being able to resolve this matter within 18 months of being retained, where the other lawyers were not able to progress the claim at all.
Insurance policies differ from personal injury and often require disputing the meaning of definitions that cannot be answered by referring to a doctor or arguing facts, requiring experts to run. At Gerard Malouf & Partners our superannuation lawyers has expertise in insurance disputes, especially TPD and income protection. Should you have a dispute in TPD or income protection, or have an inquiry as to making claims on these policies, please do not hesitate to contact our lawyers for a free consultation.