Published 30 Jun 2017
Mr H of Bidwell is our client who was in a motor vehicle accident, sustaining injury to his lower back. He additionally developed psychological illness including depression and adjustment disorder. Our client, subsequently ceased all work due to the injury.
Prior to his injury our client worked as a nurse for NSW Health. As a result of the injuries he has restrictions to lighting, twisting, turning and other motions. His psychological injury makes him unable to sustain great stress. He has received medical certification that he is unfit to work as a nurse.
Our client had approached our firm initially to conduct his motor vehicle accident claim and he had made a claim for his TPD insurance on his own. His claim for TPD was declined. The TPD insurer had acquired various medical expert reports to suggest significant residual work capacity. This created a risk to his motor vehicle claim, which was continuing at the time, for if the MVA insurer should get a hold TPD documents, it could be very damaging. It was at this stage that our client retained GMP to conduct the TPD claim. Our firm commenced proceedings at the Supreme Court of NSW.
While there is evidence to suggest Mr H has residual work capacity, we drew the insurer’s attention on the recent string of decisions from the Court that the test of whether someone is TPD is based on whether it is “realistic” the injured person can return to work. We argued that while it is theoretically possible for our client to continue work in some alternate occupation, all things being considered this is not realistic. As our client had made attempts to return to work which were not successful we argued it is unrealistic to suggest that he can return to work.
The insurer agreed to resolve this matter with our client in the amount of $60,000.00. This represents a significant percentage of the insured sum. Additionally this matter was resolved on the basis of confidentiality. Our client is greatly relieved by this outcome and happy with the money he will be receiving. He is able to focus on his rehabilitation and improving his living conditions while he awaits the conclusion of his motor vehicle accident claim.
TPD insurers and super funds, often present TPD insurance claims as being simple, especially when compared with personal injury claims. While the fund and the insurer will often inform that you are entitled to claim, what they simply mean is that you have a policy. They will when you make a claim decide whether you would be paid, engage in length investigations, and often declining the claim.
At Gerard Malouf & Partners, our solicitors have expertise in conducting total and permanent disablement (TPD) insurance claims. If you are intending to make a claim you should seek assistance from a lawyer. Our firm is able to assist you and please do not hesitate to contact our firm for a free consultation.