Published 25 May 2016
Our client is a resident of the Blue Mountains who worked as an Office Administrator for a NSW Government Department. She is aged in her mid-30s and injured while at work when she fell down a flight of stairs.
Initially, our client had retained Gerard Malouf & Partners for conduct of her Personal Injury claim for workers compensation. This was conducted successfully and she had received compensation for the Work Injury on the basis of significant impairment and received a lump sum payout.
While the Work Injury claim was being conducted by Gerard Malouf & Partners our client had attempted to claim on her TPD policy by herself. This was ultimately declined on the basis that she was not sufficiently incapacitated to be TPD.
In this case the insurer drew attention to the difference between “unable” and “unlikely”, saying the current definition of “unable to return to work” implied a higher burden of proof.
The insurer additionally argued that our client was relatively young and surgical intervention appears to have created some alleviation of the symptoms, and as such cannot be proven as unable to work.
Our client approached Gerard Malouf & Partners for advice in relation to the TPD claim and our solicitors, upon receiving instructions, commenced proceedings at the Supreme Court of New South Wales.
We argued that despite having undergone treatment, our client has not recovered sufficiently to return to work due to her significant levels of impairment, which have been documented. Additionally the correct interpretation of the policy is the wording’s usual and reasonable meaning, and we argued that our client is practically unable to work, despite being theoretically able to do limited work.
Based upon these submissions, the insurer offered to resolve this claim for $100,000.00 which represented a generous percentage of the insurance coverage. Our client was greatly relieved at the result as she was also very aware of the risks. This outcome was able to provide her with significant financial relief and finality. She is greatly happy with the services of Gerard Malouf & Partners.
TPD claims and other private insurance policies are significantly contested claims. Superannuation Funds would often give an impression as to the ease of making such a claim, without noting that these claims are often contested and held in favour of the injured party. These contests are usually heard at the Supreme Court and requires significant legal expertise.
Our lawyers have experience conducting many successful TPD claims and are happy to assist you. Please allow Gerard Malouf & Partners to assist you to achieve an outcome in your claim.