Published 11 Jul 2018
Gerard Malouf & Partners successfully represented a person with hip injury in a TPD insurance case at the Supreme Court of New South Wales. Our client was insured for total and permanent disablement (TPD) insurance in the amount of $500,000 which would respond in the event he became unable to return to work as a result of injury or illness.
In about 2010 our client fund fell from a ladder and hurting his hip. As a result of the injury he stopped work, and he hasn’t returned since due to the severe injury. Subsequently around 2012 he submitted TPD claim. The insurer took its time and arrived at a determination in 2014, and declining the claim. Their reason for saying no is on the basis that there is not sufficient evidence that our client cannot go back to work at all, and that the effects of the injury was only temporary.
It was at this point our client contacted our firm to engage this case. We observed that the insurer in declining the claim made their reason based on reports which certify our client was ill, and didn’t provide prognosis or outlook of the sickness. The insurer thus argued the evidence didn’t address the question of improvement and concludes the person can improve – which we argued was an unreasonable argument.
Our firm tendered to the insurer more definitive reports along with fresher evidence detailing the findings from the time of the injury which showed the likelihood of the person ever returning to work was slim at best – this was material the insurer should reasonably have investigated. The matter was then commenced in litigation at the Supreme Court of New South Wales against the insurer.
The insurer attempted to shift the argument during litigation upon various fronts: saying that they had too little time to consider the latest evidence which was only tendered after Gerard Malouf & Partners got involved; that the new evidence could be related to new deteriorations and not the initial condition mentioned in the reports; even the new reports did not conclude the complete inability to work; and so on and so forth. Suffice to say they threw every argument in the book at us. However it is was very clear that the arguments of our firm was the stronger.
Accordingly at the Court ordered mediation, the matter was resolved wherein our client receives $400,000.00 as settlement in order to resolve this case. Our client is greatly relieved at this outcome as the significant sum he has received from the settlement has been directed to assist his ongoing care.
Insurance policies are often far more complicated than advertised. These insurers often take vicious tactics or broad interpretations to try and avoid payment of the claim. These claims often become very complicated and requires expertise in order to effectively conduct.
At Gerard Malouf & Partners our lawyers have expertise in conducting insurance claims as held in superannuation, such as TPD or IP insurances, please contact our firm should you have a dispute or an issue with your insurance company by ringing 1300 768 780 for a free consultation.