Sandstrom v FSS Trustee Corporation & Anor [2020] NSWSC 200

Sandstrom v FSS Trustee Corporation & Anor [2020] NSWSC 200

MetLife’s decision to decline Ms Sandstrom’s TPD claim was invalid as MetLife failed to act reasonably in forming its opinion, including by misinterpreting key medical evidence, failing to address medical reports contrary to its conclusion, and by relying on vocational assessments that did not appropriately account for the plaintiff’s psychiatric disabilities. Upon fresh assessment, the Court found Ms Sandstrom satisfied the TPD definition in both policies as at the assessment date, as her prospects for regular employment for which she was reasonably qualified were, and remain, only remote or speculative.

Parties
Plaintiff: Rebecca Sandstrom; First Defendant: FSS Trustee Corporation ACN 118202672; Second Defendant: Metlife Insurance Limited
Jurisdiction
Australia
Judgment Date
09 March 2020
Procedural Posture
Principal Judgment / Final Judgment After Trial
Outcome
Plaintiff successful. MetLife’s decision set aside; plaintiff entitled to TPD benefits under both policies.
Legal Topics
Total and Permanent Disablement (tpd) Insurance, Superannuation, Utmost Good Faith in Insurance Contracts, Policy Interpretation, Medical Evidence Assessment
Equity Insurance Law Total and Permanent Disablement (tpd) Insurance Superannuation Utmost Good Faith in Insurance Contracts Policy Interpretation Medical Evidence Assessment

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Parties

Rebecca Sandstrom

Plaintiff

FSS Trustee Corporation ACN 118202672

First Defendant

Metlife Insurance Limited

Second Defendant

Procedural Posture

Principal Judgment / Final Judgment After Trial

Legal Issues

  1. 1 Whether MetLife acted with utmost good faith and reasonably in declining Ms Sandstrom’s TPD claim under the insurance policies
  2. 2 Whether Ms Sandstrom qualified as totally and permanently disabled (TPD) under the relevant policy definitions as at the assessment date

Ratio Decidendi

MetLife’s decision to decline Ms Sandstrom’s TPD claim was invalid as MetLife failed to act reasonably in forming its opinion, including by misinterpreting key medical evidence, failing to address medical reports contrary to its conclusion, and by relying on vocational assessments that did not appropriately account for the plaintiff’s psychiatric disabilities. Upon fresh assessment, the Court found Ms Sandstrom satisfied the TPD definition in both policies as at the assessment date, as her prospects for regular employment for which she was reasonably qualified were, and remain, only remote or speculative.

Court Disposition

Plaintiff successful. MetLife’s decision set aside; plaintiff entitled to TPD benefits under both policies.

Orders

  • Declare that MetLife's determination of 24 July 2015 regarding the plaintiff’s TPD claims is void and of no effect.
  • Declare that as at 9 March 2011, the plaintiff was totally and permanently disabled within the policy meanings.