Man's failed TPD claim highlights importance of medical evidence

Published 28 Jul 2017

A man who filed a total and permanent disability (TPD) claim has seen his case rejected at NSW Supreme Court after the judge ruled there was insufficient medical evidence to back his version of events.

TPD policies provide financial support to people unable to return to the workplace following a severe injury or illness, or individuals who cannot continue in a role that matched their qualifications and education.

In other words, if you can never work again or must change careers because of a serious accident, sickness or other incident, you may be entitled to a lump sum payment to cover a range of expenses.

The man in this case was pursuing $100,000 from a TPD policy for a motor vehicle crash that he was involved in eight years ago. In 2012, he filed a claim, which the insurer rejected two years later, stating he did not meet the criteria of totally and permanently disabled as outlined in the policy.

Medical evidence falls short

An important part of a successful TPD claim is obtaining medical reports indicating the individual is unable to ever return to the workplace.

The plaintiff's lawyers were only able to provide one piece of evidence in this regard - a pro-forma medical report from the plaintiff's GP.

Meanwhile, Justice Michael Pembroke said the insurer provided "copious" materials to the contrary, with at least a dozen medical practitioners assessing the plaintiff over a series of sessions. Many of these health professionals agreed the man would be able to return to the workplace, albeit in jobs that don't require heavy manual labour.

The court also heard details of the car accident, which was described as relatively minor. The man suffered no broken bones or lacerations and was released from Fairfield Hospital the same day.

Judge rejects TPD claim

Justice Pembroke said in his decision notes that the evidence suggested the plaintiff is "reluctant to work".

"I do not accept that there has been any failure by the insurer and the trustee to have regard to 'the real world' in considering whether the plaintiff was 'unlikely ever' to be able to engage in suitable employment," he stated.

"In the circumstances of this case, I have concluded that the insurer acted reasonably in forming its opinion."

This case emphasises the importance of gathering strong evidence to support your TPD claim before launching proceedings.

Gerard Malouf & Partners Superannuation Lawyers has decades of experience securing lump sum disability payments for our clients, so please get in touch to discuss your situation and see whether or not you should pursue a claim.

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