Successful TPD claim for lapsed insurance by GMP after previous lawyers had it declined

Published 17 Apr 2018

Mr E of Liverpool was injured in a work place accident when his leg was crushed at a construction site. As a result of the injury he sustained severe disabilities and had to cease work. Mr E had a Workers Compensation claim, which was conducted by another firm - that claim was uncontested and our client was awarded compensation. However this other firm had also lodged a claim for the superannuation held TPD insurance and which was declined.

The TPD insurance was in a super fund which was contributed by a previous employer for which our client did not work for at the time of the accident. The policy had a termination clause which would lapse the policy after 12 months of our client not working for that employer. It so happened that our client changed to the new employer 13 months before the accident. The insurer thus declined the TPD claim as the date our client was injured at work, was 1 day after the lapsing of the policy. The insurer refused to pay the policy as a result. This proved extremely complicated for the other solicitors and they ceased acting on that case.

Our client was in need to find new solicitors, but the injury firms which he contacted turned him away as the clauses in the contract were too complicated, that is until he contacted Gerard Malouf and Partners. Our firm observed that when the termination clause would start running was dependant on how the word, “paid”, would be interpreted in the policy. The employer had actually paid superannuation contributions in arrears to him ceasing work, and it would mean the policy would have lasted an extra month – which would cover the time of injury.

The matter was commenced at the Supreme Court of New South Wales on the question of whether “paid” in the policy meant accrued or received. The matter was listed for a hearing on this specific question. Immediately prior to the hearing the Defendants offered to resolve this matter for a large proportion of the insured sum – previously offering no money. Our client accepted the money and is very relieved that the matter was resolved in his favour.

TPD insurance claims are very complicated as they involve detailed contracts. An insurance contract claim, such as TPD or Income Protection, are frequently declined on technical reasons which can be challenged at court. At Gerard Malouf & Partners our lawyers have expertise in running TPD insurance case, and should you have a claim or dispute please contact our firm for a free consultation.

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