Published 28 Oct 2015
Ms Ziogos was a former NSW Police Officer who developed Post-Traumatic Stress Disorder, anxiety and depression over the course of her employment. She became Totally and Permanently Disabled and was unable to continue working.
She lodged a claim under two TPD insurance policies taken out by her superannuation company First State Superannuation with the insurer MetLife.
Ms Ziogos’ treating doctor was very supportive of her claim and confirmed that she was Totally and Permanently Disabled. MetLife organised for Ms Ziogos to be examined by two other doctors who gave less favourable reports.
One doctor reported that “with treatment” Ms Ziogos would be able to work again. Ultimately MetLife declined Ms Ziogos’ claim and she commenced proceedings in the Supreme Court.
The Supreme Court Justice’s Findings
In this case Justice Ball examined the law surrounding the insurer’s duty to act with the utmost good faith in making a determination. Justice Ball held that “the requirement of utmost good faith requires the insurer to explain how it reached the decision it did so that the insured person can be satisfied that the decision itself was reached in the utmost good faith.”
The Court found that MetLife had breached its duty in several ways. One way that it breached its duty was by relying on the doctors report that stated “with treatment” Ms Ziogos could work again. The insurer did this without taking any steps to determine whether Ms Ziogos would in fact receive that treatment.
The Court then considered whether Ms Ziogos was Totally and Permanently Disabled within the meaning of the insurance policy. Justice Ball found in Ms Ziogos’s favour and she was awarded the full amount of her claim - $935,865, with the opportunity to make submissions to the Court to recover legal fees.
Your TPD Claim
Many TPD policies allow for claims for psychological and mental health conditions that render you permanently unable or unlikely to engage in work again. However, it is often necessary to fight the insurance company’s initial determination to achieve justice.
At Gerard Malouf and Partners we know exactly what you need to do to lodge a successful claim and fight against an unsuccessful claim.
If you have already lodged a claim that has been rejected we are willing to take your case all the way to the Supreme Court of NSW if the insurer has breached their duty to act with the utmost good faith and not acted reasonably.
Call us today to speak with one of our experts in Superannuation and Insurance law.