Hawkins v. Scottish Mutual Assurance Plc [2005] ScotCS CSOH_101 (02 August 2005)

Hawkins v. Scottish Mutual Assurance Plc [2005] ScotCS CSOH_101 (02 August 2005)

The policy requires that the opinion triggering entitlement to TPD benefit must be from a medical practitioner considered by the insurer to be qualified and whose opinion is specifically required by the insurer. Reports obtained by the pursuer or his agents do not satisfy this requirement. The only relevant opinion is that of Dr Junaid, instructed by the insurer, but his report is unclear and self-contradictory, requiring clarification at proof. The claim for damages for late payment is subject to the general rule that only interest is recoverable unless special circumstances are established.

Citation
[2005] ScotCS CSOH_101
Parties
Pursuer: David Andrew Hawkins; Defender: Scottish Mutual Assurance Plc
Jurisdiction
Scotland
Judgment Date
02 August 2005
Procedural Posture
Civil (insurance Contract Dispute) / Opinion on Procedure Roll (interim Ruling)
Outcome
No decree granted; case to proceed to proof before answer for clarification of medical evidence and further examination of damages claim.
Legal Topics
Construction of Insurance Policies, Total Permanent Disability Benefit, Proof of Claim Clauses, Damages for Breach of Contract, Interpretation of Medical Evidence
Insurance Law Contract Law Construction of Insurance Policies Total Permanent Disability Benefit Proof of Claim Clauses Damages for Breach of Contract Interpretation of Medical Evidence

Case Brief

Summary, issues, holding and outcome

More case intelligence is available

Unlock the full research layer for this judgment.

Full judgment text Downloadable case file Legal principles 4 Authorities cited 6 Party arguments 2 Amounts and remedies 3
Sign in to unlock

Parties

David Andrew Hawkins

Pursuer

Scottish Mutual Assurance Plc

Defender

Procedural Posture

Civil (insurance Contract Dispute) / Opinion on Procedure Roll (interim Ruling)

Legal Issues

  1. 1 Whether the pursuer is entitled to Total Permanent Disability (TPD) benefit under the insurance policy based on medical evidence and policy construction
  2. 2 Whether the pursuer is entitled to damages for breach of contract for late payment of the sum assured

Ratio Decidendi

The policy requires that the opinion triggering entitlement to TPD benefit must be from a medical practitioner considered by the insurer to be qualified and whose opinion is specifically required by the insurer. Reports obtained by the pursuer or his agents do not satisfy this requirement. The only relevant opinion is that of Dr Junaid, instructed by the insurer, but his report is unclear and self-contradictory, requiring clarification at proof. The claim for damages for late payment is subject to the general rule that only interest is recoverable unless special circumstances are established.

Court Disposition

No decree granted; case to proceed to proof before answer for clarification of medical evidence and further examination of damages claim.

Orders

  • Restricted proof before answer ordered to clarify the opinion of Dr Junaid and to determine whether the pursuer meets the policy conditions for TPD benefit.
  • Damages claim for breach of contract to proceed to proof to determine relevancy and foreseeability of consequential losses.