Forestville Woman Wins TPD Claim Under ‘Home Duties’ Definition 1 Month After Claim Lodged

Published 10 Jan 2019

Author: Jesicca Yousif

Ms D of Forestville was a 57-year-old woman who ceased employment in 2008 for reasons unrelated to illness. However, in late 2013 Ms D became symptomatic of Multiple Sclerosis though not formally diagnosed until late 2015.

During this time, Ms D had been engaged in ‘Home Duties’ including, but not limited to, cooking family meals, cleaning the home, doing the laundry, taking care of children or other dependents, including bathing, dressing and counselling, doing the family grocery shopping and general maintenance around the home. 

By 2014, Ms D’s symptoms were quite extensive and included vision problems, tingling and numbness in her extremities, pains and spasms, weakness, fatigue and cognitive loss, amongst various other physical and psychological conditions. Taken as a whole, Ms D physical and psychological symptoms substantially interfered with her ability to undertake the full suite of Home Duties that she had been independently responsible for prior to July 2014.

Ms D was initially unaware that she held insurance cover for such circumstances however wasted no time in contacting Gerard Malouf and Partners on becoming aware of the cover.

Our expert solicitors swiftly commenced their investigations of a Total and Permanent Disablement (TPD) claim on behalf of Ms D.  Our Solicitors undertook appropriate investigations to determine that Ms D would not be eligible to claim TPD under the standard policy definitions that required a connection between the date ceased work and that date Ms D became ‘disabled’. However, upon further enquiry it become apparent that Ms D could be eligible to claim TPD under the alternative ‘Home Duties’ definition.

Our team were able to demonstrate that multiple Sclerosis is a condition characterised by a gradual onset of symptoms which increase over time. This was particularly challenging due to the disconnect between date ceased work and date of disablement together with the scarcity of medical evidence.

A claim was submitted against the Superfund and approved in full for a sum of over $215, 000 in just over a month after the claim was lodged.

Ms D was extremely grateful as the insured benefit will be instrumental in alleviating her families financial burdens.

A claim for ‘Total and Permanent Disablement’ is often lodged on the basis of ceasing work as a result of injury or illness. In this instance, the Insurer’s Policy held an alternative definition of ‘Total and Permanent Disablement’. A TPD claim is not always a straight forward process. There are various definitions that may be available under a Policy and the terms can become quite technical. Seeking legal advice can be the difference between a claim being approved or a being declined.

Contact Gerard Malouf and Partners on 1800 004 878 who can help confirm whether you hold insurance cover and also determine your eligibility to claim.

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