Long v IS Industry Fund Pty Ltd [2020] NSWSC 1151

Long v IS Industry Fund Pty Ltd [2020] NSWSC 1151

Hannover's third and fourth rejections were void as breaches of duty to Mr Long—the insurer adopted an incorrect construction of the policy definition regarding causation, failed to fairly consider later medical evidence, and did not employ a reasonable determination process. The requirement of causation in the TPD policy did not mandate that termination for misconduct preclude entitlement if incapacity followed as an immediate result of illness or injury. However, as to the alternative claim, Mr Long failed to establish the requisite period of employment under the policy's terms, and that rejection was valid.

Jurisdiction
Australia
Judgment Date
27 August 2020
Procedural Posture
Equity Proceedings / Determination of Separate Question Regarding Validity of Insurer's Decisions to Reject TPD Claims; Future Case Management Pending
Outcome
Third and fourth rejections of Mr Long's TPD claim declared void and without effect due to breach of Hannover's duties; alternative claim rejected. Orders to be proposed by parties for case management and effecting judgment; costs reserved to final hearing.
Legal Topics
['life Insurance' 'accident and Sickness' 'total and Permanent Disablement (tpd)' 'policy Interpretation' "reasonableness of Insurer's Decision" 'breach of Duty' 'construction of Insurance Contracts']
['insurance' 'equity'] ['life Insurance' 'accident and Sickness' 'total and Permanent Disablement (tpd)' 'policy Interpretation' "reasonableness of Insurer's Decision" 'breach of Duty' 'construction of Insurance Contracts']

Case Brief

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Procedural Posture

Equity Proceedings / Determination of Separate Question Regarding Validity of Insurer's Decisions to Reject TPD Claims; Future Case Management Pending

Legal Issues

  1. 1 ["Whether Hannover's decisions to decline the plaintiff's TPD claim involved breaches of duty and obligations rendering those decisions void" 'Proper construction of TPD policy definition and work requirements' "Reasonableness and adequacy of Hannover's reasoning process in rejecting claims" 'Relevance and weight of medical evidence remote from the relevant date']

Ratio Decidendi

Hannover's third and fourth rejections were void as breaches of duty to Mr Long—the insurer adopted an incorrect construction of the policy definition regarding causation, failed to fairly consider later medical evidence, and did not employ a reasonable determination process. The requirement of causation in the TPD policy did not mandate that termination for misconduct preclude entitlement if incapacity followed as an immediate result of illness or injury. However, as to the alternative claim, Mr Long failed to establish the requisite period of employment under the policy's terms, and that rejection was valid.

Court Disposition

Third and fourth rejections of Mr Long's TPD claim declared void and without effect due to breach of Hannover's duties; alternative claim rejected. Orders to be proposed by parties for case management and effecting judgment; costs reserved to final hearing.

Orders

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