Denial of income protection claim by insurer results in great result for client

Published 04 Sep 2014

Mrs B had been employed as a full time nanny for many years when she unfortunately injured herself in the course of her employment. She had previously purchased a private income protection insurance within her superannuation account and felt secure in the knowledge if something ever happened to her she would be covered.

After extensive surgery and treatment, her injury to her elbow did not resolve. She tried to return to work however the restrictions and pain prevented the undertaking of her usual duties. Mrs B then turned to the policy which she knew she had in a time when she really needed to be paid the benefit.

Unfortunately for our client her insurer appeared to deliberately avoid the policy by not assessing her entitlements correctly, not obtaining relevant information for the assessment and they also relied upon incorrect evidence and ultimately made a decision to deny liability in the claim. Submissions were made on behalf of Mrs B in relation to the management of the file and the incorrect evidence relied upon by the insurer however they failed to review the claim adequately and reinstated their decision to deny the claim.

Gerard Malouf & Partners then commenced proceedings in the Supreme Court and only then was her claim assessed how it should have been in the first instance. The insurer involved in this matter has a fairly large share of the banking and insurance market and insure many Australians for the same cover in the event that the unfortunate does occur and you are unable to work.

Ultimately, our clients case was settled by way of an informal settlement conference and the client was very happy to finally receive what she had always been entitled to. Mrs B can now make plans for the future with the knowledge that her policy ultimately provided for a time when she really needed it.

If you are experiencing any difficulties or would like to speak to one of our specialist superannuation team members, please call us for an obligation free initial consultation to see how we may assist you in navigating around your insurance company.

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