Edser v QSuper Board [2021] FCA 1437

Edser v QSuper Board [2021] FCA 1437

AFCA erred in law by misapplying the correct standard for 'related to' in clause 6.2(b): the proper test requires a clear causal connection between pre-existing condition and TPD, not mere but-for causation nor mere non-causal 'clear connection'. The decision was thus set aside and remitted for redetermination applying the correct legal standard.

Parties
Applicant: Shanon Edser; First Respondent: QSuper Board; Second Respondent: Australian Financial Complaints Authority Limited
Jurisdiction
Australia
Judgment Date
18 November 2021
Procedural Posture
Appeal / Judgment After Hearing of Appeal on a Question of Law
Outcome
Appeal allowed; AFCA determination set aside and remitted for redetermination in accordance with reasons.
Legal Topics
AFCA Determinations, Total and Permanent Disablement Benefits, Pre Existing Medical Condition, Interpretation of Exclusion Clauses, Appeal on Question of Law
Administrative Law Superannuation Law Insurance Law AFCA Determinations Total and Permanent Disablement Benefits Pre Existing Medical Condition Interpretation of Exclusion Clauses Appeal on Question of Law

Case Brief

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Parties

Shanon Edser

Applicant

QSuper Board

First Respondent

Australian Financial Complaints Authority Limited

Second Respondent

Procedural Posture

Appeal / Judgment After Hearing of Appeal on a Question of Law

Legal Issues

  1. 1 Whether AFCA failed to consider mandatory relevant considerations
  2. 2 Proper construction of 'pre-existing medical condition' under insurance terms
  3. 3 Correct interpretation of 'not related to' in exclusionary clause for TPD benefits

Ratio Decidendi

AFCA erred in law by misapplying the correct standard for 'related to' in clause 6.2(b): the proper test requires a clear causal connection between pre-existing condition and TPD, not mere but-for causation nor mere non-causal 'clear connection'. The decision was thus set aside and remitted for redetermination applying the correct legal standard.

Court Disposition

Appeal allowed; AFCA determination set aside and remitted for redetermination in accordance with reasons.

Orders

  • The determination made by the Australian Financial Complaints Authority on 26 February 2021 be set aside.
  • The matter be remitted to the Australian Financial Complaints Authority for redetermination in accordance with these reasons.