Wheeler v FSS Trustee Corporation as trustee for the First State Superannuation Scheme [2016] NSWSC 534

Wheeler v FSS Trustee Corporation as trustee for the First State Superannuation Scheme [2016] NSWSC 534

MetLife's rejection of the TPD claims was invalid because it failed to act reasonably: it discounted probative later psychiatric evidence merely because it post-dated the assessment date, treated the marital separation as an intervening cause without adequate medical basis, relied on opinions of Dr Burek that addressed the wrong test or were unexplored, continued to rely on vocational reports after their medical foundation had been removed, and drew its own adverse conclusions from investigation material without expert psychiatric input. MetLife also breached its duty of good faith and fair dealing by taking control of the investigation, refusing for years to provide material to Ms...

Jurisdiction
Australia
Judgment Date
29 April 2016
Procedural Posture
Equity Proceeding Concerning Claims for Total and Permanent Disablement Benefits Under Superannuation Insurance Policies / Principal Judgment After Hearing
Outcome
MetLife's rejection of Ms Wheeler's TPD claims was held invalid; constructive denial was established; Ms Wheeler was held to satisfy the TPD definitions and to be entitled to TPD benefits, interest as applicable, and costs from MetLife.
Legal Topics
['total and Permanent Disablement Benefits' 'life Insurance' 'construction of "unlikely Ever"' "insurer's Duty of Good Faith and Fair Dealing" "reasonableness of Insurer's Determination" 'constructive Denial of Claim' 'procedural Fairness in Claims Assessment']
['insurance' 'superannuation' 'equity'] ['total and Permanent Disablement Benefits' 'life Insurance' 'construction of "unlikely Ever"' "insurer's Duty of Good Faith and Fair Dealing" "reasonableness of Insurer's Determination" 'constructive Denial of Claim' 'procedural Fairness in Claims Assessment']

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Procedural Posture

Equity Proceeding Concerning Claims for Total and Permanent Disablement Benefits Under Superannuation Insurance Policies / Principal Judgment After Hearing

Legal Issues

  1. 1 ["Whether MetLife constructively denied Ms Wheeler's TPD claims by delaying determination and withholding materials gathered in its investigation." "Whether MetLife's rejection of the TPD claims was invalid because it failed to act reasonably, in good faith and with fair dealing." 'Whether later medical evidence could be used to assess whether the TPD definitions were satisfied as at 21 March 2011.' "Whether Ms Wheeler's marital breakdown or alcohol use were intervening factors preventing satisfaction of the TPD definitions." 'Whether Ms Wheeler was, as at the assessment date, incapacitated to such an extent as to render her unlikely ever to engage in relevant work for which she was reasonably qualified by education, training or experience.']

Ratio Decidendi

MetLife's rejection of the TPD claims was invalid because it failed to act reasonably: it discounted probative later psychiatric evidence merely because it post-dated the assessment date, treated the marital separation as an intervening cause without adequate medical basis, relied on opinions of Dr Burek that addressed the wrong test or were unexplored, continued to rely on vocational reports after their medical foundation had been removed, and drew its own adverse conclusions from investigation material without expert psychiatric input. MetLife also breached its duty of good faith and fair dealing by taking control of the investigation, refusing for years to provide material to Ms...

Court Disposition

MetLife's rejection of Ms Wheeler's TPD claims was held invalid; constructive denial was established; Ms Wheeler was held to satisfy the TPD definitions and to be entitled to TPD benefits, interest as applicable, and costs from MetLife.

Orders

  • ['The parties are to bring in short minutes of order to give effect to the reasons for judgment.' "If agreement can be reached, the Court will make the orders in chambers; if not, the matter can be relisted by arrangement with the judge's associate." "The Insurer must pay Ms Wheeler's costs of the proceedings."]