Shuetrim v FSS Trustee Corporation [2015] NSWSC 464

Shuetrim v FSS Trustee Corporation [2015] NSWSC 464

The decisions of TAL and MetLife declining the claim were vitiated for breach of the insurers’ duty of good faith and fair dealing due to inadequacy and unreasonableness in their consideration of pertinent medical and vocational evidence; the plaintiff, on the medical and other evidence at the relevant date, was unlikely ever to engage in any occupation for which he was reasonably qualified by education, training or experience, and was thus entitled to total and permanent disability benefits under both policies.

Jurisdiction
Australia
Judgment Date
24 April 2015
Procedural Posture
Equity Proceedings (insurance/superannuation Benefits) / Principal Judgment at Trial
Outcome
Plaintiff entitled to declarations and payment of total and permanent disability benefits under both TAL and MetLife insurance policies.
Legal Topics
['total and Permanent Disability Benefits' 'duty of Good Faith and Fair Dealing' 'interpretation of Insurance Policies' 'superannuation Group Insurance' 'claims Process Under Insurance Policies' 'disability Definition—superannuation']
['contracts' 'insurance Law' 'superannuation Law' 'equity'] ['total and Permanent Disability Benefits' 'duty of Good Faith and Fair Dealing' 'interpretation of Insurance Policies' 'superannuation Group Insurance' 'claims Process Under Insurance Policies' 'disability Definition—superannuation']

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Procedural Posture

Equity Proceedings (insurance/superannuation Benefits) / Principal Judgment at Trial

Legal Issues

  1. 1 ['Whether the insurers breached their duty of good faith and fair dealing by delay or by their decisions' 'Whether the plaintiff satisfies the definition of total and permanent disability under the relevant insurance policies' "Proper construction of 'total and permanent disablement' under TAL and MetLife policies" 'What is the relevant date for assessment of disability' 'Evidentiary onus regarding incapacity for work']

Ratio Decidendi

The decisions of TAL and MetLife declining the claim were vitiated for breach of the insurers’ duty of good faith and fair dealing due to inadequacy and unreasonableness in their consideration of pertinent medical and vocational evidence; the plaintiff, on the medical and other evidence at the relevant date, was unlikely ever to engage in any occupation for which he was reasonably qualified by education, training or experience, and was thus entitled to total and permanent disability benefits under both policies.

Court Disposition

Plaintiff entitled to declarations and payment of total and permanent disability benefits under both TAL and MetLife insurance policies.

Orders

  • ['Declarations that the TAL and MetLife decisions of 17 December 2014 and 23 January 2015 are void and of no effect' 'Plaintiff satisfies total and permanent disability definitions in the respective policies' 'TAL and MetLife to pay plaintiff the insured sums under the basic and Blue Ribbon policies' 'Interest under...