Insurance company loses appeal over rejection of TPD benefit

Date:Dec 21, 2018

A former police officer in NSW faced an appeal regarding her insurance benefits. She had experienced severe psychological injuries that prevented her from working.

The insurance provider rejected multiple claims and recently sought to appeal a decision that was made in the woman's favour.

Background

The former police officer (the respondent) claimed benefits under the First State Superannuation scheme. Her insurance provided cover for total and permanent disablement (TPD), which is what the respondent had made a claim to. The policy stated that TPD could be provided if she had not been working as a police officer for six consecutive months, whether from injury or illness. 

The woman had been a police officer from May 2001 to August 2010. She said that she experienced several traumatic events around the start of her service until early 2008. After this, she had to undergo treatment for anxiety and depression. She also said that she had to engage in 'non-operational duties' at work because of her condition.

She hasn't worked since she left her position in 2010, and thus the six months required under her insurance policy were over in March 2011. She then applied to receive the TPD compensation in 2012, with support from a medical professional indicating that she had PTSD and a major depressive disorder.

However, over four years later, the woman's insurance provider (the appellant) came back and said she did not meet the TPD requirements to receive benefits. This came after two previous claim rejections.

The initial trial had taken place regarding these three rejections from the insurance provider. The judge ruled that the company had dismissed certain key evidence about the respondent's condition, and that it had ignored the medical evidence regarding professional opinions about her psychological injuries.

Details of the appeal

The appeal from the insurance company now in question, claimed that one of the initial rejections from the Supreme Court of New South Wales was not 'valid and effective'. 

The judge in the Court of Appeal said that the original finding should be upheld and the appeal should be dismissed. This decision was based on the fact that the insurance company had 'breached its obligation to act reasonably and fairly' when dealing with the situation.

Another reason was that the appellant had incorrectly handled medical reports and opinions in the original case.

If you believe you may be eligible to receive benefits from your superannuation policy, get in touch with us at Gerard Malouf & Partners Compensation, Medical Negligence & Will Dispute Lawyers for a free consultation.

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