Published 22 Nov 2017
Our client, Ms N was a former nurse at Wollongong. She had suffered an injury to her back while working, which caused her extreme ongoing pain and made her unable to return to work. She initially approached our firm for workers compensation. She had Total and Permanent Disablement (TPD) insurance of $125,000.00 held in a super fund but decided to claim this herself which was subsequently declined.
The basis of the decline was that the evidence did not support our client could not return to all kinds of work, and the insurer also alleged further deteriorations could not be considered as it was only developed long after Ms N had stopped all work. Ms N had made multiple representations to the insurer hoping to change their mind, but when these were not successful. She subsequently sought our firm’s assistance.
Our firm, upon being retained, quickly examined the case and observed that the evidence to date was unclear as to the issue of when and what made our client unable to work in any capacity. We proceeded to acquire evidence to clarify that point, and to strengthen the case, showing that from the time of ceasing work Ms N was arguably too ill to ever work again. With such evidence available we proceeded to court, and with a hearing imminent, the insurer agreed to have negotiations to resolve this case.
The insurer at negotiations, while attacking the evidence, accepted that if our arguments was well received by the Court, our client would be successful. They offered $100,000.00 for resolution of this dispute, being a significant percentage of the insurance sum. Our client is exceptionally relieved resolving this case, and the monies alleviates her financial strain and assist in her continuing recovery.
TPD and other insurances differ from personal injury as they involve complicated insurance contracts. Often, insurers will decline claims with reference to issues regarding when the disablement occurred, which is something worded into the contract, and is technical. Lots of individuals attempt these claims personally with great risk of prejudice.
At Gerard Malouf & Partners our lawyers have expertise in insurance claims for TPD and income protection, and should you have a claim or intend to make a claim please do not hesitate to contact our lawyers for a free consultation.