Newling v FSS Trustee Corporation (No 2) [2018] NSWSC 1405

Newling v FSS Trustee Corporation (No 2) [2018] NSWSC 1405

MetLife did determine the claim by deciding that it was not satisfied that the plaintiff had provided proof of TPD. It was not under a general contractual obligation to give reasons, and in any event its correspondence sufficiently disclosed that the claim had not overcome the opinions of Dr Robinson and Dr Ng. The plaintiff, represented by solicitors, was given a fair opportunity to respond to adverse material including surveillance and expert reports. On the material before MetLife, including conflicts in medical opinion, the surveillance, vocational evidence, uncertainties in the plaintiff's self-reported disabilities and the absence of affirmative evidence that she could not obtain...

Jurisdiction
Australia
Judgment Date
14 September 2018
Procedural Posture
Claim for Total and Permanent Disablement Benefit Under a Group Life Insurance Policy / Separate Questions in Principal Judgment
Outcome
Separate questions answered No; proceedings dismissed with costs.
Legal Topics
['total and Permanent Disablement Benefit' "proof to Insurer's Satisfaction" "insurer's Duty to Act Reasonably and Fairly" 'duty of Utmost Good Faith' 'separate Questions' 'assessment of Conflicting Expert Medical Evidence']
['insurance' 'practice and Procedure'] ['total and Permanent Disablement Benefit' "proof to Insurer's Satisfaction" "insurer's Duty to Act Reasonably and Fairly" 'duty of Utmost Good Faith' 'separate Questions' 'assessment of Conflicting Expert Medical Evidence']

Case Brief

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Procedural Posture

Claim for Total and Permanent Disablement Benefit Under a Group Life Insurance Policy / Separate Questions in Principal Judgment

Legal Issues

  1. 1 ['Whether MetLife breached its duty to the plaintiff in declining the TPD claim.' 'Whether MetLife failed to act reasonably in considering and determining its opinion.' 'Whether MetLife formed an opinion that was not open to it acting reasonably and fairly in the consideration of the claim.' 'Whether MetLife failed to consider and determine whether it should form an opinion on whether the policy definition of Total and Permanent Disablement was satisfied.']

Ratio Decidendi

MetLife did determine the claim by deciding that it was not satisfied that the plaintiff had provided proof of TPD. It was not under a general contractual obligation to give reasons, and in any event its correspondence sufficiently disclosed that the claim had not overcome the opinions of Dr Robinson and Dr Ng. The plaintiff, represented by solicitors, was given a fair opportunity to respond to adverse material including surveillance and expert reports. On the material before MetLife, including conflicts in medical opinion, the surveillance, vocational evidence, uncertainties in the plaintiff's self-reported disabilities and the absence of affirmative evidence that she could not obtain...

Court Disposition

Separate questions answered No; proceedings dismissed with costs.

Orders

  • ['Order that the questions reserved by order of the Court on 10 November 2017 be answered as follows: (i) No. (ii) No. (iii) No. (iv) No.' 'Order that the proceedings be dismissed.' "Order that the plaintiff pay the defendant's costs."]