Former police officer claims total and permanent disability cover

Published 05 Sep 2018

The First State Superannuation Scheme is provided to NSW police officers. Under this coverage, total and permanent disability (TPD) coverage is available if a member is no longer able to work because of illness or injury. The person must be under 65 and have an active insurance policy in place at the time they cease employment.

Determining whether or not a person actually has TPD is not always easy. A recent case brought these guidelines into question in NSW.

A police officer questions two claim rejections

A NSW police officer (the plaintiff) left his post after suffering post-traumatic stress disorder (PTSD) symptoms. He claimed that while working undercover, he had been attacked multiple times. In one instance, he had gone undercover as a drug dealer. The incident resulted in him being robbed, and his life was threatened.

The plaintiff says that he now suffers from chronic PTSD as a result of these violent and stressful incidents.

He is a member of the First State Superannuation Scheme for NSW police officers. This policy provides insurance coverage to its members. The FSS Trustee Corporation, on behalf of the Scheme, was the first defendant in the case. The second defendant was the plaintiff’s other insurance provider, MetLife.

In 2012, the plaintiff had filed a claim with both defendants that he had TPD coverage under his insurance plan. He claimed that he was therefore entitled to receive over $600,000 under the policies. His insurance provider rejected the claims in 2014 and again in 2017.

The defendants found that the man was not totally and permanently disabled and therefore did not qualify.

The previous decisions are set aside by the court

In the proceedings before the Supreme Court of NSW, the plaintiff aimed to challenge these earlier decisions. He claimed that because of his PTSD, he was eligible for TPD coverage since he could no longer work.

After evaluating both previous decisions by the defendants, the judge ruled to set aside both of them. It was found that the insurance provider had breached its duty to act reasonable in regards to the plaintiff’s claim.

It was then suggested that a second stage inquiry take place, and that the second defendant pay the plaintiff’s costs.

If you believe you are eligible to make a claim regarding a superannuation dispute, get in touch with us at Gerard Malouf & Partners Compensation, Medical Negligence & Will Dispute Lawyers. We can assist you throughout the process and help you understand your rights.

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