GMP negotiates $40,000 settlement after insurer rejects Total and Permanent Disablement claim

Published 01 Jun 2016

Our client was a 55 year old mother who returned to the workforce in 2002 as a process worker after 11 years raising her young children. She was able to perform her job successfully without any issues for around 5 years. However in 2007 she began to develop pain in her hands and wrists, particularly on the left side.

Over the next year she tried to treat her symptoms in a variety of ways including switching to restricted/lighter duties at work, using wrists splints and inflammatory creams and undergoing a steroid injection in her finger. In 2008 she underwent surgery on the tendons in her left wrist. Unfortunately these treatments did not resolve her issues and she was retrenched in late 2008.

Our client remained off work until 2010 when she attempted to get back to work by undertaking a brief work trial. The trial was unsuccessful and she remained unable to work.

In 2013 our client became aware that her superannuation company had taken out a Total and Permanent Disablement (TPD) Insurance policy on her behalf. She came to Gerard Malouf and Partners for help making her claim.

We confirmed her benefit with the superannuation company and assisted her in completing and submitting the required claim forms. We also sent our own submissions detailing our client’s injuries and inability to work.

Ultimately our client’s claim was rejected by the insurer as they did not believe she satisfied their policy’s definition of Total and Permanently Disabled. We immediately briefed one of our experienced barristers for his advice on taking the insurer to court to recover our client’s TPD benefit. At the same time we commissioned a further report from an expert Orthopaedic Surgeon to bolster our client’s case.

After commencing proceedings in the Supreme Court against the insurer and superannuation company we received the surgeon’s supportive report. This report detailed our client’s history, attempts to work and the extent of her injuries, outlining exactly how she satisfied the policy definition of Totally and Permanently Disabled.

There was however some risk involved with the case as our client’s injuries came on gradually and deteriorated overtime. This is less clear cut than a case where a single incident and injury causes a person to become disabled. Understanding this risk our client agreed to engage in settlement negotiations.

At the settlement conference the parties were able to agree to settle in the amount of $40,000. This was a great result for our client as her total insured benefit amount was only $50,000. She was able to recover the majority of the benefit without the stress and cost involved in taking her case all the way to a hearing at the Supreme Court.

If you are no longer able to work due to an injury or illness you may also be entitled to make a Total and Permanent Disablement claim through your superannuation fund. These claims can be very complex however and insurers often put up a strong fight to avoid paying out. You need an experienced lawyer to be sure you end up with the best outcome.

At Gerard Malouf and Partners we have the knowledge and experience to assist you throughout all the stages of making a Total and Permanent Disablement insurance claim. If you believe you might be eligible contact one of our expert solicitors today.

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