Jones v United Super Pty Limited [2016] NSWSC 1551

Jones v United Super Pty Limited [2016] NSWSC 1551

The insurer's and trustee's decisions were void because the insurer took too narrow a view of whether the plaintiff was unlikely to be able to engage in regular remunerative work, failing to consider psychological obstacles and competitive disadvantages, and because it wrongly treated entry-level jobs unrelated to the plaintiff's education, training and employment as jobs for which he was reasonably fitted by education, training or experience. On the substituted determination, the plaintiff was unable to follow his usual occupation as a roof plumber by reason of accident or illness for six consecutive months from 10 October 2011, and his education, training and experience fitted him only...

Jurisdiction
Australia
Judgment Date
02 November 2016
Procedural Posture
Equity Proceedings Concerning a Total and Permanent Disablement Insurance Benefit Under a Superannuation Fund / Principal Judgment After Hearing on Challenge to Insurer and Trustee Declinature Decisions
Outcome
The decisions of the insurer and trustee should be declared void; the plaintiff should be declared totally and permanently disabled within the meaning of the insurance policy; the insurer should pay the sum insured with interest to the trustee and the trustee should pay it to the plaintiff.
Legal Topics
['total and Permanent Disablement' 'accident and Sickness Insurance' 'group Life Policy' "review of Insurer's Opinion" 'education, Training or Experience Clause' 'regular Remunerative Work' 'superannuation Trustee Decision Making']
['insurance' 'superannuation' 'equity'] ['total and Permanent Disablement' 'accident and Sickness Insurance' 'group Life Policy' "review of Insurer's Opinion" 'education, Training or Experience Clause' 'regular Remunerative Work' 'superannuation Trustee Decision Making']

Case Brief

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Procedural Posture

Equity Proceedings Concerning a Total and Permanent Disablement Insurance Benefit Under a Superannuation Fund / Principal Judgment After Hearing on Challenge to Insurer and Trustee Declinature Decisions

Legal Issues

  1. 1 ["Whether the decisions of the insurer and trustee declining the plaintiff's TPD claim were void." 'Whether the insurer applied too rigorous a test to the phrase "unlikely ever" in the policy definition of total and permanent disablement.' "Whether the insurer failed to take into account psychological obstacles, including fear-avoidance syndrome, and competitive disadvantages affecting the plaintiff's ability to engage in work." 'Whether proposed occupations such as hardware retail sales, courier or delivery driver, console operator and customer service adviser or telemarketer were work for which the plaintiff was reasonably fitted by education, training or experience.' 'Whether the plaintiff was unable to follow his usual occupation by reason of accident or illness for six consecutive months.' 'Whether the Court should substitute its own decision and declare the plaintiff totally and permanently disabled within the policy meaning.']

Ratio Decidendi

The insurer's and trustee's decisions were void because the insurer took too narrow a view of whether the plaintiff was unlikely to be able to engage in regular remunerative work, failing to consider psychological obstacles and competitive disadvantages, and because it wrongly treated entry-level jobs unrelated to the plaintiff's education, training and employment as jobs for which he was reasonably fitted by education, training or experience. On the substituted determination, the plaintiff was unable to follow his usual occupation as a roof plumber by reason of accident or illness for six consecutive months from 10 October 2011, and his education, training and experience fitted him only...

Court Disposition

The decisions of the insurer and trustee should be declared void; the plaintiff should be declared totally and permanently disabled within the meaning of the insurance policy; the insurer should pay the sum insured with interest to the trustee and the trustee should pay it to the plaintiff.

Orders

  • ['The decisions of the insurer and the trustee should be declared void.' 'It should be declared that Mr Jones is totally and permanently disabled within the meaning of the insurance policy.' 'Hannover Life Re of Australia Limited should be ordered to pay the sum insured, together with interest pursuant to s 57 of...