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NSW Police Officer Awarded $788,000 After Claim Was Declined By Insurer

Ms Hellessey, a former member of the NSW Police Force ceased employment on 30 August 2010 after she was diagnosed with Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder as a result of events that occurred during the course of her employment.

In 2012 Ms Hellessey lodged a TPD claim with the First State Superannuation Scheme on the basis that by reason of her psychological injury, she satisfied the Total and Permanent Disability (TPD) definition and was thus entitled to the TPD insurance benefit.

Ms Hellessey in her Affidavit filed in Court provided a detailed account of events that she witnessed or was exposed to while in the Police Force which lead to her injury. Ms Hellessey in particular made reference to a number of traumatic experiences, which included fatal motor vehicle accidents, cases of murder, suicides, death and abuse of children, drug and alcohol abuse, violent crimes, violent criminals and other traumatic incidents.

Despite the traumatic experiences, Ms Hellessey in her evidence noted that she did not start to suffer from psychological symptoms until late 2004 when she felt humiliated by a colleague in the workplace. Ms Hellessey gave evidence that in 2004 she was seated at her desk when a male colleague approached her from behind and removed her pistol from her holster and began to waive it around in the air and then pointed it at her. He then began to throw the bullets at her, in which they hit the metal seat and made loud noises. Ms Hellessey was fearful that the gun was going to be discharged and felt humiliated by the incident.

This was the beginning for what was about to be a a tough period for Ms Hellessey who continued with her employment duties and continued to attend accident/crime scenes that left her physically ill, nauseous and overwhelmed.

On 6 December 2004 Ms Hellessey attended upon her treating doctor who certified that she was unfit to work for a short period following the diagnosis of anxiety and conversion reaction.  After a short period off work, Ms Hellessey returned to the police force until she was placed on restricted duties permanently and given a clerical role at the Police Academy from 2008 to 2010. During this period Ms Hellessey continued to attend upon her treating doctors and was being treated for her psychological injuries.

On 31 August 2010 Ms Hellessey suffered a panic attack whilst at work and was certified unfit to work by her treating doctor and has been unable to return to her occupation since this date.

After her claim was declined on three occasions, Ms Hellessey commenced proceedings in Court against MetLife, stating that they had unreasonably declined her claim and that she is incapacitated by her psychological injury in a manner that satisfied the TPD definition in the policy.

In the evidence relied upon by MetLife, it was submitted that Ms Hellessey had not become incapacitated to such an extent to render her as unlikely to ever engage in gainful profession, trade or occupations for which she was reasonably qualified by reason of education, training or experience. MetLife in particular made reference to Ms Hellessey’s regular Facebook activities/statuses, her attendance at social events and opinions of medical experts to persuade the Court that she did not have social phobia, and with time may be able to return to the workforce, thus not satisfying the TPD definition.

The evidence relied upon by MetLife in assessing Ms Hellessey’s claim made no reference to the report of her treating Psychiatrist, Dr Durrell, whom she was under the care of for a long period. It was raised my Ms Hellessey’s Solicitors that MetLife failed to give weight to the vital evidence provided by her treating psychiatrist, who was familiar with her injuries and had certified her as unfit to return to her employment duties.

In the Judgement handed down, the Court found that Ms Hellessey was incapacitated by her psychological injury in a manner that satisfied the TPD definition in the policy, and was therefore entitled to judgement for the amount of the benefits plus interest to be calculated and costs.

His Honour noted at paragraph [1002] that: “I accept the consistent evidence of the medical professionals who have expressed opinions on the subject that Facebook posts made in the privacy of the home of a person suffering PTSD and depression should not be taken at face value for the purpose of drawing conclusions about the true psychological state of the author of the posts.” His Honour explained the fact that Ms Hellessey participated in social activities, whether it be her attending a horse show, going shopping or attending other social events, was not inconsistent with her suffering from social phobia.

His Honour concluded that all of the medical evidence relied upon in Court formed the opinion that the nature of her injuries were chronic and she was unlikely to be able to engage in employment for which was qualified for. This matter highlights that insurers when assessing a TPD claim have an obligation to review and consider all expert and lay evidence when making their final decision.

If you have been diagnosed with psychological and are no longer able to continue your employment duties, than you may be entitled to lodge a TPD claim with your Superannuation Policy. If you would like any assistance in preparing and lodging your TPD Claims, please feel free to contact  our No Win No Fee Lawyers on our toll free contact number, 1800 004 878 and arrange a no obligation consultation with one of our Superannuation Lawyers.

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Gerard Malouf & Partners
 — Personal Injury Compensation Lawyers

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