Former maintenance fitter receives $425,000 settlement on TPD insurance claim

Published 31 Aug 2016

Our client was a 51 year old former maintenance fitter who suffered an injury to his foot during a workplace accident. He continued to work for several years while suffering pain from his foot injury, however over time the condition worsened and he began limping.

Due to the deterioration of his symptoms our client’s GP referred him to an Orthopaedic Surgeon who recommended surgery. Our client underwent the recommended operation but it did not relieve his pain. Soon after the operation he was made redundant from his job.

Our client continued to suffer from pain which radiated to his calf, thigh, knee and back. He was on a variety of medications to treat his pain and improve his sleeping pattern. Over time our client also developed psychological symptoms including depression as a result of his pain and inability to work. This further contributed to his total and permanent disability.

As it was clear that our client would never be able to return to work he lodged a Total and Permanent Disablement (TPD) insurance claim based on TPD cover that he held through his superannuation fund.

Unfortunately, the superannuation fund and their insurer did not approve the payment of our client’s disability benefits. He came to Gerard Malouf and Partners to see if we could help with reversing the decision. We were happy to assist him on a No Win No Fee basis.

After reviewing the documentation provided by the client we came to conclusion that the insurer had been unreasonable in denying our client’s TPD claim. We considered that there was sufficient merit to sue the insurer in the Supreme Court of NSW.

We commenced proceedings and continued gathering evidence for our case. While our client’s physical pain and symptoms had been well documented in his medical records we needed further evidence of his psychological symptoms. We had our client assessed by one of our expert Psychiatrists who prepared a report that was supportive of his permanent disability.

After completing the preparation of our case we attended a Court ordered informal settlement conference to try to resolve the matter prior to the Hearing. The conference was a success and after several hours of negotiations the insurer agreed to pay our client $425,000 to settle the matter and discontinue the court case.

Our client was happy with this result as this gave him a swifter resolution than proceeding all the way to the Hearing and helped to immediately alleviate some of his financial hardship.

If you have made, or are interested in making a TPD claim contact Gerard Malouf and Partners today. Our TPD lawyers are experts in superannuation law and making successful TPD claims. Call us now to find out how we can assist you.

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