Published 14 Jul 2017
Our client, Mr J is a resident of Beverly Hills and was a former bank manager. He was dismissed from work subsequent to allegations of misusing funds, although these allegations were never substantiated, and he was not convicted.
Our client was insured under income protection policy with the bank’s super fund. He had put in a claim after he stopped work. The insurer had initially paid on the basis of psychological injury, but they stopped after a few payments. They alleged our client had not kept up with his treatment and was only unable to work because of the disciplinary action. Our client retained the assistance of Gerard Malouf & Partners to conduct his case. We commenced proceedings at the Supreme Court of NSW against the insurer.
We firstly noted that our client had kept up his treatment to the extent that he had attended to his doctors regularly. While he has not attended to the treatment specifically advised by his GP there has been divergent opinion on what treatment he should have. In those circumstances our client has “complied with treatment” under the policy which does not specify with clarity the exact meaning of “compliance with treatment”.
Secondly, we argued that it is not acceptable to allege that our client is able to work and is not unable to work because of illness by reference to his disciplinary action which was not pursued further or investigated by the Police. There is a psychological illness diagnosed around the time of the ceasing of work which we argued would satisfy the requirement that our client had stopped work and simultaneously is unable to work as a result of illness or injury.
The matter was commenced at the Supreme Court and the matter was ultimately resolved prior to Hearing. The insurer, despite previously being completely intransigent agreed to pay our client $50,000.00, which represents approximately half the payments to which our client otherwise have been entitled to. Our client is greatly relieved at the conclusion of this matter and was happy that this money is available to him for him to now focus on his rehabilitation and retraining. The client currently undertakes a University Degree to transition into the Marketing profession.
At Gerard Malouf & Partners, our solicitors have expertise in conducting insurance claims of income protection and total and permanent disablement. If you contemplate making a claim or are having any issues with your claim, please do not hesitate to contact our solicitors for a free consultation.