Folan v United Super Pty Ltd [2014] NSWSC 343

Folan v United Super Pty Ltd [2014] NSWSC 343

The Court held that the Insurer and Trustee's decisions were unreasonable and invalid because they lacked a reasonable evidentiary foundation for concluding that suitable regular remunerative work was available to the plaintiff, failed to address the real-world likelihood of him obtaining such work, failed to make or pursue necessary inquiries about his occupational suitability and work availability, and failed at reconsideration stages to give fair and genuine consideration to the plaintiff's statement and later medical and physiotherapy evidence. On the uncontradicted material, properly considered, the plaintiff was within the policy definition of TPD and entitled to the $100,000 benefit.

Jurisdiction
Australia
Judgment Date
27 March 2014
Procedural Posture
Superannuation Claim for Total and Permanent Disablement Benefit Under a Trust Deed and Group Life Insurance Policy / Principal Judgment After Hearing
Outcome
The plaintiff's challenge succeeded; the Insurer's and Trustee's declinature decisions were held unreasonable and invalid, and the plaintiff was found entitled to the TPD benefit of $100,000.
Legal Topics
['total and Permanent Disablement Benefits' 'group Life Insurance' 'trustee Duties in Determining Superannuation Claims' 'insurer Duty of Utmost Good Faith' 'reasonableness and Validity of Claim Declinature Decisions']
['superannuation' 'insurance' 'trusts'] ['total and Permanent Disablement Benefits' 'group Life Insurance' 'trustee Duties in Determining Superannuation Claims' 'insurer Duty of Utmost Good Faith' 'reasonableness and Validity of Claim Declinature Decisions']

Case Brief

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Procedural Posture

Superannuation Claim for Total and Permanent Disablement Benefit Under a Trust Deed and Group Life Insurance Policy / Principal Judgment After Hearing

Legal Issues

  1. 1 ["Whether the Insurer's decisions to decline the plaintiff's TPD claim were unreasonable and invalid." "Whether the Trustee's decisions to decline the plaintiff's TPD claim were unreasonable and invalid." 'Whether the plaintiff was unlikely ever to be able to engage in any Regular Remuneration Work for which he was reasonably fitted by education, training or experience.' 'Whether the Trustee and Insurer failed to undertake reasonable inquiries and give real and genuine consideration to the material before them.']

Ratio Decidendi

The Court held that the Insurer and Trustee's decisions were unreasonable and invalid because they lacked a reasonable evidentiary foundation for concluding that suitable regular remunerative work was available to the plaintiff, failed to address the real-world likelihood of him obtaining such work, failed to make or pursue necessary inquiries about his occupational suitability and work availability, and failed at reconsideration stages to give fair and genuine consideration to the plaintiff's statement and later medical and physiotherapy evidence. On the uncontradicted material, properly considered, the plaintiff was within the policy definition of TPD and entitled to the $100,000 benefit.

Court Disposition

The plaintiff's challenge succeeded; the Insurer's and Trustee's declinature decisions were held unreasonable and invalid, and the plaintiff was found entitled to the TPD benefit of $100,000.

Orders

  • ['The Court proposed to make declarations in terms of prayers 1, 2, 3, 4 and 5 of the Further Amended Statement of Claim.' 'The Court proposed to make orders in terms of prayers 6, 7 and 8 of the Further Amended Statement of Claim.' "The defendants are to pay the plaintiff's costs." 'The parties are directed to...