TPD insurer reverses declinature and awards $400,000 for brain symptomology caused by past substance use

Published 27 Jul 2016

Our client is Mr G of Hornsby and worked as a truck driver.  He developed significant brain symptomology caused by past substance use.  He had ceased the use of substances for many years up to the onset of his condition which subsequently rendered him incapable of working.  In addition to the brain condition he has also developed depression.

Mr G had decided to make a claim on a total and permanent (TPD) policy as held by his superannuation fund himself.  After a period of two years of going back and forth the insurance company rejected his claim on the basis there was not sufficient evidence to show that Mr G has become completely incapable of ever returning to work as a result of his conditions.

Mr G contacted Gerard Malouf and Partners to challenge their insurer’s refusal to make payment.  We identified that there was no real basis for the insurer to refuse the claim and began preparations for commencement of proceedings against the insurer for failure to make payments.  

We issued a final warning to the insurer prior to the commence of proceedings, and the insurer reversed their decision and admit the payment of $400,000 representing the TPD benefit.

Mr G is very happy with the outcome and of the representation by Gerard Malouf and Partners.  This money greatly alleviates the financial difficulties he is facing caused by his physical and mental conditions.

TPD claims are “all or nothing” types of claims.  They are commercial litigation which usually commences at the Supreme Court of New South Wales.  Insurance companies often make suggestion as to the ease of a successful TPD application. But the experiences of many people is the opposite. There are an increasing number of judgements at the Supreme Court  OF NSW relating to TPD claims as a result.  

Gerard Malouf and Partners has extensive experience in conducting TPD claims before and after commencement of Court proceedings and achieving many successful outcomes.  If you have an enquiry about a TPD claim or require assistance in the conducting of your claim please do not hesitate to contact our solicitors for a free consultation and allow us to assist you to achieve a successful outcome.

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