Standley v Onepath Life Ltd [2020] NSWSC 848

Standley v Onepath Life Ltd [2020] NSWSC 848

Although the Plaintiff was not totally and permanently disabled as at May 2016, the TPD policy did not restrict the three month assessment period to the initial absence; a later three month absence could be used, provided the insured was disabled at the end of that period such that they were unlikely ever to return to their own occupation. By September 2017, the Plaintiff’s psychological condition rendered him unlikely ever to return to his own occupation, and the claim should have been accepted. The insurer’s refusal breached the contract.

Parties
Plaintiff: Mr Aaron Standley; Defendant: Onepath Life Ltd
Jurisdiction
Australia
Judgment Date
12 June 2020
Procedural Posture
Principal Judgment / Final Decision
Outcome
Plaintiff's claim succeeds
Legal Topics
Total and Permanent Disability (tpd) Insurance, Life Insurance, Interpretation of Insurance Policies, Assessment of Disability, Breach of Contract
Insurance Law Equity Total and Permanent Disability (tpd) Insurance Life Insurance Interpretation of Insurance Policies Assessment of Disability Breach of Contract

Case Brief

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Parties

Mr Aaron Standley

Plaintiff

Onepath Life Ltd

Defendant

Procedural Posture

Principal Judgment / Final Decision

Legal Issues

  1. 1 Whether Mr Standley qualified for a TPD benefit under an insurance policy due to physical and/or psychological incapacity
  2. 2 Whether assessment of ‘unlikely ever’ test and the three month period under the TPD policy must be conducted only at the end of the first three month absence, or could be later
  3. 3 Whether physical or psychological impairment prevented the Plaintiff’s return to his 'Own Occupation' as defined in the policy

Ratio Decidendi

Although the Plaintiff was not totally and permanently disabled as at May 2016, the TPD policy did not restrict the three month assessment period to the initial absence; a later three month absence could be used, provided the insured was disabled at the end of that period such that they were unlikely ever to return to their own occupation. By September 2017, the Plaintiff’s psychological condition rendered him unlikely ever to return to his own occupation, and the claim should have been accepted. The insurer’s refusal breached the contract.

Court Disposition

Plaintiff's claim succeeds

Orders

  • Judgment for the Plaintiff; parties to agree on amount of the judgment sum (including any interest) and be heard on costs