Woman awarded $90,000 after successful TPD claim

Published 17 Oct 2018

A woman who suffers from crippling psychological injuries following a series of traumatic events has succeeded after a $90,000 total and permanent disability (TPD) claim.

The plaintiff, who previously worked as a community development officer and counsellor, was involved in a serious car accident in 2006. She claimed the police officers investigating the crash later assaulted her, including sexually, while she was in custody.

Prior to the incident, the woman had suffered from depression and anxiety, but her symptoms became far worse and she developed post-traumatic stress disorder and agoraphobia. Dealing with the police and court appearances were particular triggers for her.

In late 2007, the plaintiff began working for her former employer but she was forced to stop in January 2008 due to her psychological injuries. She has not worked since.

Why didn’t the insurer pay out?

The exact wording of TPD policies varies from insurer to insurer, but many rely on the same principles and criteria for approving a payout. Claimants must first have been unable to return to work for a specified time period, which was six months in this particular case.

Furthermore, after this timeframe elapses, the insurer must generally be satisfied the individual is unable to work again in a role for which they are reasonably qualified by education, training or experience.

The insurer in this case rejected the claim on two fronts:

  1. The medical evidence did not support the conclusion the plaintiff was unable to work because of injury or illness when she ceased employment in January 2018.
  2. The evidence available did not suggest the plaintiff would never be able to work again as at July 2018 – six months from the date of disablement.

Insurer errors brought to light

Justice Philip Hallen ruled the insurer was incorrect in both elements of its reasoning for rejecting the claim. He argued there was significant medical evidence to show the plaintiff was suffering serious mental health problems at the time she ceased work, including drug prescriptions for her depression and anxiety.

The judge also noted the terms of the policy did not require the woman to show she wouldn’t ever return to work by the assessment date, only that she was unable to go back to her job at that time. This is a much lower threshold and warranted the $90,000 TPD payout.

Ultimately, insurance policies are designed to ensure people are able to access financial support when unforeseen circumstances strike. But insurers don’t always have claimants’ best interests at heart, which is why you should always obtain expert legal advice on whether or not to accept a decision.

Please contact a no-win, no-fee lawyer at Gerard Malouf & Partners Superannuation Lawyers to find out if you are entitled to life insurance benefits.

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