TPD Claim Rejected Despite the Wrong Definition

An insurer recently argued in a case in the District Court in Brisbane, that despite using an incorrect definition of total and permanent disablement in rejecting the claim, the decision they had formed was still correct and they had not make any mistake.

The definition the insurer used was “regular remunerative work” for which he or she is reasonably suited by education, training and experience instead of the correct definition which was any “occupation” based on the skills and knowledge the person has acquired through previous education, training and experience.

This difference in terminology is extremely important and must be noted. Further the Court also found that the insurer failed to consider relevant medical information when they were forming their decision to reject the claim.

The insurer refused to accept it made any mistake by referring to the incorrect definition and the claimant was successful in setting aside the decision.

This goes to show that where an insurer makes errors it cannot just wave them off as technicalities and that a Court will hold them to account for not following their own policies.